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TENANT FINISH / COMMERCIAL REMODEL PERMIT APPLICATION tf>,J ! • c0c. .,sf> COMMUNITY DEVELOPMENT: BUILDING DEPARTMENT One Descombes Dr • Broomfield, CO 80020 • Office [PHONE REDACTED] • Faix [PHONE REDACTED] • 0 cl Permit Number Date Received Address of Proposed Construction Subdivision Lot Block I Property Owner Owner Email Address (required) Owner Phone Number Owner's Address (if different from above) City, State, Zip Contractor Contractor Phone Number Contractor License Number Contractor Address City, State, Zip Job Contact Name Contact Office Phone Number Contact Mobile Phone Number Job Contact E-Mail Address Job Contact Title Project Valuation (Including total value of 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, and fences require separate permits! Description of Construction (be specific and complete all lines below) Building Height: I Number of Stories: I IBC Construction Type: I IBC Occupancy Class: Fire Sprinklers? □ Health Dept contacted? Fire Dept contacted? Is this a new business/location? Existing bldg use: Sq. ft. Used as: □ Sq. ft. □ Used as: Sq. ft. □ Used as: Sq. ft. Used as: TOTAL AREA: Hazardous Materials stored or used? YesD NoD If yes, provide list and maximum quantities 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. 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. I Signature: Print Name Legibly: Date: I l l l Office Use Only l 1 1 Building Dept. Approval: Date: I Building Division, June 2024 I