Fillable COMMERCIAL BUILDING PERMIT APPLICATION CHECKLIST Polk County Public (Polk County)

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COMMERCIAL BUILDING PERMIT APPLICATION CHECKLIST Polk County Public (Polk County)

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The COMMERCIAL BUILDING PERMIT APPLICATION CHECKLIST Polk County Public (Polk County) form is 2 pages long and contains:

  • 2 signatures
  • 13 check-boxes
  • 52 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Polk County

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Polk County Public Works
5885 NE 14
th
Street
Des Moines, IA 50313
Phone (515) 286-3705
Fax (515) 2
86-3437
email:
PublicWorks@polkcountyiowa.gov
Is a new address needed? Yes No
Project Address:
Checklist of items to be completed prior to submitting application:
Building Permit Application
Site Plan has been approved
Detailed Construction Plans
–
1
set
PDF, 1 set hard copy
Truss Specifications
Septic o
r Sewer (check on line):
If a septi
c system is needed, results of a Soils Analysis or Soil Perc Test and Septic System Permit must be
submitted
If san
itary sewer is available, complete a Sanitary Sewer Connection Permit and Agreement
Entrance Permit application
Water:
Publi
c water service connection fee
Water Ser
vice Provider
Geothe
rmal Well Permit (if applicable) for vertical geothermal wells. A permit is not required for horizontal
system
Right – o
f – way grant permit (if applicable) for work within road right – of – way
Notice: All electrical, mechanical, plumbing and fire sprinkler permits must be applied for
separately. All work must be permitted prior to inspection.
Unresolved Zoning, Subdivision, Floodplain, Health items may delay the issuance of any
permit. No construction shall start until the permit is issued. No structure should be used or
occupied until the certificate of occupancy is issued.
Contractor/Owner/Applicant Signature:
I have included all the above checked items and I understand that all the items listed above must be received andfees
paid before a permit will be issued. I further understand that construction work cannot begin until the building
permit has been issued. All the information supplied by me is true and correct to the best of my knowledge and
belief.
*Please allow 7-10 business days for permit review and approval.
Print Name Signature Date
Email: Phone #:
COMMERCIAL BUILDING PERMIT APPLICATION CHECKLIST
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signature
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JOB SITE ADDRESS: ________________________________________ TOWNSHIP: __________________________
OWNER: ___________________________________________________ PHONE: (_______) ________ - ___________
ADDRESS: ___________________________________________________ CITY: ________________________ STATE: ______ ZIP CODE: _________
CONTRACTOR: ____________________________________________ PHONE: (_______) ________-____________
COMPANY: _____________________________________________
ADDRESS: ___________________________________________________ CITY: ________________________ STATE: ______ ZIP CODE: _________
Description of proposed building: - (please describe proposed project)
____________________________________________________________________________________________________________________________
Proposed use: - (please state the use of proposed building and site if different)
____________________________________________________________________________________________________________________________
(please circle one of the choices below)
OTHERDEMOMOVE-ONADD/ALTNEW
Height of Proposed Building?
Fill in the square footage of proposed building in appropriate row
ValuationRateSquare Feet
Commerc
ial/ Industrial
Building 1
st
Floor
2
nd
Floor
Mezzanine
Canopy
Addition
Accessory Structure
Other: _____________
_______
TOTAL VALUATION
_____ Entrance Pe
rmit PERMIT FEE
_____ Septic Perm
it PLAN REVIEW FEE (65%)
____
Geothermal
TOTAL BUILDI
NG
_____ Sewer Permit
SEPTIC PERMIT FEE
Water Source: GEOTHE
RMAL FEE
_____ Well ENTRANCE PERMIT FEE
_____ Public ___________ TOTAL FEE
Work must commence within 180 days from permit issuance date, and be completed and inspected within one year from the permit issuance date, or the building permit
will be null and void. I understand all work must be inspected and approved by Polk County prior to concealing any installation and that I must call for a final
inspection. I further understand that a Certificate of Compliance or Certificate of Occupancy/Use is required in accordance with applicable codes and ordinances.
_____I affirm I am the owner or licensed contractor of this property and I am building the structure for the above stated use. I affirm that the work described in this
application is accurate and correct to the best of my knowledge and belief. I hereby acknowledge that I have read this permit and state that the above information is
correct, and agree to comply with all ordinances and state and federal laws regulating activities covered by this permit.
*Please allow 10-7 business days for permit review and approval.
_______________________________________Date__________
Signature
GeoParcel: _________-_____________-________-________
District/Parcel: _________-
_____________-________-________
Permit #______________________
Polk County Public Works
5885 NE 14
th
Street
Des Moines, IA 50313
Phone (515) 286-3705 Fax (515) 286-3437
email: PublicWorks@polkcountyiowa.gov
COMMERCIAL BUILDING PERMIT APPLICATION
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COMMERCIAL BUILDING PERMIT APPLICATION CHECKLIST Polk County Public (Polk County)

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Completed 14 February 2021

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