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I~ ' • • fi One De5Comliles Dr • llrt10mfield, CO 1!10020 • Office [PHONE REDACTED] • Fax 303.43,8.6207 • ~ . COMMUNITY DEVELOPMENT: BUILDING DEPARTMENT I I I I I I I I I I NEW COMMERCIAL BUILDING PERMIT APPLICATION Date Permit Number Address of Proposed Construction Subdivision Lot Block Property Owner Owner Phone Number Owner’s Address (if different from above) City, State, Zip Contractor Contractor Phone # Contractor License Number Contractor Address City, State, Zip Job Contact Name Contact Office Phone Number Contact Mobile Phone Number Job Contact EMail Address Job Contact Title Project Valuation (Including total value of vertical work, materials, labor, overhead and profit) BMC §15-03-100 Trade Valuation Name of Subcontractor General: $ Electrical: $ HVAC: $ Plumbing: $ Fire Sprinkler: $ Total: $ All signs, construction trailers, grading, landscape irrigation, site improvements, and fences require separate permits! Indicate actual distance to property line below Front Setback: Left Side Setback: Right Side Setback: Rear Setback: Description of Construction: Building Height: Number of Stories: IBC Construction Type: IBC Occupancy Class: Fire Sprinklers: Area of 1st Floor: Use of 1st Floor: Number of Elevators: Area of 2nd Floor: Use of 2nd Floor: Soil Report Number: Area of 3rd Floor: Use of 3rd Floor: By: Area of 4th Floor: Use of 4th Floor: Foundation Type: Total Area: Livable Square Footage: Hazardous Materials stored or used? Yes No If yes, provide list and maximum quantities Affordable Housing Square footage: It is the owner’s responsibility to obtain any Architectural Control Committee approvals that may be applicable. I hereby state that the above is correct. I recognize that the approval of plans, issuance of a permit, or subsequent inspection approvals shall not be construed to allow violations of the code or other ordinances or laws enforced by the City and County of Broomfield. I consent to provide entry to inspectors as set forth in the building code and to request inspections as required. I consent to pay the use tax based upon the purchase price of all building and construction materials, as required by ordinance. I understand records are subject to audit and verification for 3 years following final inspection or C.O. Broomfield Municipal Code requires taxpayers to maintain building use tax records for 3 years. All materials, drawings, plans, or documents submitted for this permit become public record and may be released to the public. By signature below the signatory certifies and declares that he/she is either the Owner or the Authorized Agent of the owner of the property. Signature: Print Name Legibly: Date: ↓ ↓ ↓ Office Use Only ↓ ↓ ↓ Building Dept. Approval: Date: Building Division, Revised October 30, 2025