Customer (Builder): ______________________________________________________________________

Customer Address:________________________________________________________________________

Customer Phone:__________________Fax:_______________, Mobile____________, Pager________________

Contact Person ________________________________ email address_______________________________

Job Name: _______________________________________________________________________________

Address of Job: _________________________________________________________________________________

Nearest Crossroad or landmark:_______________________________________________________________

Governing Jurisdiction: (City, County, Township, etc.) ____________________________________________

Are these plans Preliminary or Final? (Circle one)

On what date do you anticipate us starting _____/_____/_____ or completing this project? _____ / _____ /______

What is the Condition of Lot? (circle all that apply) Wooded, Paved, Sod, Plowed, Level, Steep Hill, Gentle slope? Other

If sloped, does the lot nearly match the foundation design?___________________________________________

Please describe lot if unusual: do you have pictures or drawings of the lot?__________________________________

Drainage: Natural Drain, Sump Pump, or Both? (Circle one)

Are there any conditions which may limit our access? i.e.: low power lines, ditches, creeks or sidewalks to cross,

trees, tight lots, etc.)_____________________________________________________________________

Will a concrete pump be needed? For Footers: Yes or No ~ Walls: Yes or No ~ Floors: Yes or No

Please estimate Top of Wall elevations from existing ground (how far will foundation be out of existing ground?):

__________ at garage, __________ at porches, __________ at slab

Which parts of this project may we price for you? (please circle the items needed)

   --Layout: Is the foundation location established? _____ ~ If Yes, are off sets or foundation corners marked?

   If No, would you like us to do this for you? ______

   --Excavation: _________ Drive Base:__________ Backfill w/ Rough Grade:_______

   --Dirt Trucking: _____ ~ If Yes, on lot or off lot, where to?________________________________________

   --Footers: __________ ~ size:_________________________________________

   --Walls: _______~ thickness:________ ~ Height_______

   --Tile & Waterproofing: _____ ~ If Yes, Form A Drain _______ 4" Perforated Tile________

   --Interior Flatwork: ______________________

   --Exterior Flatwork: _____________________

   --Complete Package: _____ ("The Whole Enchilada" ~ Remember, we're at our best when we do it all!)

Please sign: _____________________________________ and Date: _________________

The Lavy Concrete Team Thanks you for the chance to earn your Job !