Permit Number:___________________________
Project Address:
Permit No. (if applicable):_______________________
Owner:
City & State:
Zip: Phone:
PROPERTY LOCATION:
North South East West side of:
(street name):
Applicant:
Address:
City & State:
Zip: Phone:
between (street name):
and (street name):
Property Address:
Engineer:
Address:
City & State:
Zip: Phone:
Section ______ Township ______ Range ______
Assessor’s Parcel No.
SUMMARY OF REQUEST (List type of uses)
____________________________________________
Total sq. ft. of site:
Total sq. ft. in buildings:
Total sq. ft. in paved and covered surfaces (include
buildings, driveways, streets, sidewalks, parking lots)
FOR OFFICE USE ONLY
Administration Fee $ 30.00
Plan Review Fee $______________
Deposit Amount $______________
Receipt Number _______________
A check of the approved plans against the revised plans will be made by the City. If the plans meet the minimum
requirements as to content, they will be routed to the appropriate City staff and the plan review process will
begin. If minimum requirements are not met, plans will be returned to submitting engineer.
Application for PLANS CHANGE
City of DuPont
Building Services Division
1700 Civic Drive DuPont, WA 98327
P: (253) 912-5217 F: (253) 964-1455
www.dupontwa.gov
OFFICIAL USE ONLY
Date Received _______
Received By _________
