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11. Property Owner Consent:
The application must be signed by all the Titleholders, Contract Purchasers, or Option Purchasers of the subject
property. The
application may also be signed by the Registered Agent for a corporation or other person with similar legal
authority to sign for a property owner. (if additional signatures are needed please attach)
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Signature
date
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Signature date
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Signature date
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Signature
date
_________________________________
(Print Name)
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(Print Name)
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(Print Name)
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(Print Name)
12. Written description:
Please provide a written description providing specific detail and reasons for the proposed request. (Attach if necessary)
Optionally attach any additional information including concept plans for the proposed development or use.
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Return completed forms to: Polk County Public Works, Planning & Development Division
5885 NE 14
th
Street, Des Moines, IA 50313
▪ Phone (515) 286-3705 ▪ Fax (515) 286-3437 ▪
Forms available online http://www.polkcountyiowa.gov/PublicWorks/
Zoning Commission Calendar
Zoning Comm Calendar
A completed application with required information and filing fee must be submitted.
Incomplete submittals will not be processed and will be returned to the Applicant.
OFFICIAL USE ONLY
Date Received Received by
P&Z meeting date BOS meeting date
BOS Approved Y / N Effective date
email: PublicWorks@polkc
ountyiowa.gov
click to sign
signature
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signature
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