Building Department
21630 11th Avenue South, Suite D
Des Moines, WA 98198
(206)870-7576 fax:(206)870-6544
www.desmoineswa.gov
Change of Information
Project Name:
Project Address:
Name:
Address: City: State:
Zip:
Phone:
Fax:
Name:
Address: City: State: Zip:
Phone: Fax:
Email:
Email:
WA Contractor License #:
Des Moines Business License #:
Print name of Owner of Record
Owner of Record signature
Date:
Date:
Scope of
Change:
Office use only:
Associated Permit Number:
PLEASE NOTE: CHANGES IN OWNERSHIP ARE NOT ACCEPTED ON THIS FORM
Please note: Changes in personnel, project contacts, or addresses listed on original application or original documents for an active
project will not be accepted unless noted on this completed and signed Change of Information form. Detailed information regarding
such will be required each time a change occurs. Incomplete forms may not be accepted.
Received By:
Date:
Change approved by:
Change denied by:
Reason (if any) for denial:
Date entered into system: Person inputting new data:
Former:
Contractor Architect/Designer
Engineer Project Contact
Company Name:
New:
Contractor Architect/Designer Engineer Project Contact
Company Name:
WA Contractor License #:
Des Moines Business License #:
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome