Permanent Improvement or Addition

NOTE: The owner is responsible for contacting the Polk Co. Building Division and obtaining all required Permits. Additionally, the owner is responsible for any/all damage to common areas and/or other lots, including roads, utilities, curbing, etc.

Submit at least FIVE working days PRIOR to construction start date

Lot # / Street *

Shareowner’s Name *

First

Last

Shareowner’s Email Address *

Email

Confirm Email

Confirmation will be emailed to this address.

Shareowner’s Phone Number *

Description of Improvement or Addition *

Is a Polk County Permit Required? *

• Yes. I will submit the Permit# now.
• Yes. I will submit the Permit# BEFORE work begins.
• No. I have verified with Polk County that no permit is required.

Polk County Permit # *

Permit# Submission Agreement *

• I understand that I must resubmit this form with the Permit# prior to start of work.

Polk County Contact’s Name. *

Contractor’s Name *

Construction Start Date

Date

Time

Construction End Date

Date

Time

Upload Scanned Copy or Photo of Work Diagram Here (If Applicable)

Click or drag files to this area to upload. You can upload up to 2 files.

Diagram must include improvement or addition dimensions within the lot measurements and Polk County setbacks.

Upload Scanned Copy or Photo of Polk County Permit Here (If Applicable)

Click or drag a file to this area to upload.

Management or Board Review

Submit