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

"*" indicates required fields

Lot # / Street*

Shareowner’s Name*

First Last

Shareowner’s Email Address*

Enter 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

Construction End Date

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

Drop files here or

Max. file size: 64 MB, Max. files: 2.

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)*

Drop files here or

Max. file size: 64 MB.