Program Description & Interest Form - StopWaste.Org

Project Interest Form ( * Indicates required field)Applicant Information*Today’s Date: ____________________*Building Owner/Operator:*If the above contact is not the owner, is s/he authorized to make building improvements? __Y __N*Primary Contact Person, Title:*Address, City, ZIP:*Primary Phone:*E-mail:Alt. Phone:Project Contacts*Project Manager (Name, Title):*Company/Organization:*Phone: _________________ *Email: _____________Architect (if applicable): __________________________________________________________________Firm:Phone: _________________ Email: ____________General Contractor (if applicable): __________________________________________________________Firm:Phone: _________________ Email: ____________Specialty contractor/other (if applicable): ____________________________________________________Firm:Phone: _________________ Email: ____________Scope of Work*Project Name:*Project Address, City:*Building Type:*Total Building Area (sf):*Project (Scope of Work) Area (sf):Total Project Cost $ Expected Budget forBuilding Materials$Number of FloorsBuilding Vintagewww.stopwaste.org/smallcommercial page 3

* The project can be described as (Check all that apply):NewConstruction(not eligiblefor program)ComprehensiveRehabPartialRetrofit/upgradesRehabilitation (Rehab) / RetrofitUpgrade attenantturnoverUpgradecentralsystemsAdditionOther :________*Utility Information (Check all that Applicant pays for)Utility Provider Name /Description of SystemElectricityNatural GasWaterSpace HeatDomestic Hot WaterSpace HeatDomestic Hot WaterIndoor WaterShared RestroomsIrrigationCentrallyMeteredMetering (if known)IndividuallyMeteredSub-metered*Brief description of the project (2-4 sentences): _______________________________________________Project Timeline*Current Project Status:*Expected Design Completion Date:*Expected Construction Start Date:*Expected Construction Completion Date:____________________________.____________________________.____________________________.____________________________.www.stopwaste.org/smallcommercial page 4