Tenant Space / Tenant Use Review
(for change in Tenant or “character” of a previously authorized use of any building, or portion thereof)
This form is intended to assist the City in determining whether a proposed “use” of a building, tenant space, or any portion
thereof conforms to Codes and Regulations as may be applicable. Please complete this form with all necessary information
requested below to allow staff to process your request / Permit Application in a timely manner. Provide diagrams, floor plan
layouts, and related information, where available.
(Note: All applications must be signed by the building owner or tenant. Commercial tenant spaces must also be accompanied with a copy of a signed lease
agreement, or other form of owner’s approval for the intended use of the tenant space.)
(Information to be completed by applicant)
TENANT IMPROVEMENT SUBMITTAL CHECKLIST
(IF A BUILDING PERMIT IS REQUIRED)
BUILDING SERVICES DIVISION
1700 Civic Drive DuPont, WA 98327
P: (253) 912-5217 F: (253) 964-1455
www.dupontwa.gov
Proposed Business Type (or use):_______________Proposed Tenant/Business Name:__________________
Proposed Tenant Owner’s Name:_____________________________________________________________
Address:_____________________________________________________Phone:______________________
Anticipated Date of Business Opening at this location:_____________________________________________
Previous Business Type (if applies):_____________ Previous Tenant Business Name:___________________
Owner of Building:_______________________________Contact Info:________________________________
Is the business a change in use (business type) from the previous tenant, or a new use in previously unoccupied area?
(If yes, a Building Permit will be required and a Certificate of Occupancy must be issued prior to any use or occupancy) ___Y ___N
Contractor:_____________________________________ State Lic______________________ City Lic___________
Is any remodeling of the space required or planned for the space under consideration? ___Y ___N
(If yes, a Building Permit will be required and a Certificate of Occupancy issued.)
Contractor:_____________________________________ State Lic______________________ City Lic___________
Is any Plumbing or Mechanical work required or planned with the new use? ___Y ___N
(If yes, a Plumbing or Mechanical Permit will be required prior to commencing the work.)
Contractor:_____________________________________ State Lic______________________ City Lic___________
Contractor:_____________________________________ State Lic______________________ City Lic___________
(NOTE: If all answers above are “NO,” a Pre-Opening Safety Inspection must be completed prior to conducting business. Please
contact the Building Services Division to coordinate this inspection.)
IMPORTANT: By signing below I acknowledge that the above is true and accurate information.
I am the: Owner of the Building Tenant (must provided a copy of a signed lease agreement)
Signed:_______________________________________________________________________________________
Signature of Responsible Party of Record (Printed Name) Date
STAFF REVIEW (attach comments or requirements for deferred submittals)
Proposed use is a Group________________, Division__________________ Occupancy (per ______________IBC), Permit Application submitted: Y / N
Previous use was a Group_______________, Division__________________ Occupancy (per_______________IBC)
Reviewed By: (Indicate approval Yes (Y) No (N))
Planning Dept____________________ Public Works Dept______________ Engineering Fire Dept
Pierce County Utilities___________________Pierce County Health__________________BUILDING DEPT
PROJECT NAME: __________________________________________________________________________________
PROJECT ADDRESS:_______________________________________________________________________________
DESCRIPTION OF BUSINESS (be specific):_____________________________________________________________
