Polk County Public Works
5885 NE 14
th
Street
Des Moines, IA 50313
publicworks@polkcountyiowa.gov
515-286-3705
Finished Basement or Interior Remodel Permit Application and Checklist
JOB SITE ADDRESS: ________________________________________________
OWNER: ____________________________________________________________ PHONE: _______________________________________
ADDRESS: _____________________________________________ CITY: ______________________ STATE: _______ ZIP: ________________
EMAIL: ____________________________________________________________________________________________________________
CONTRACTOR: _______________________________________________________ PHONE: _______________________________________
COMPANY: __________________________________________________________
ADDRESS: _____________________________________________ CITY: ______________________ STATE: _______ ZIP: ________________
EMAIL: ___________________________________________________________________________________________________________
Area of basement to be finished (dimensions): _________X__________ Total square feet: ______________
Valuation of proposed improvements of interior remodel: ___________________
What will the proposed space be used for? (family room, office, bedroom, bathroom, etc.): _______________________________________
_____________________________
_____________________________________________________________________________________
Are you adding bedrooms? YES NO
*If yes, see emergency egress windows information sheet
# of bedrooms to be added: _____ + existing # of bedrooms in home: _____ = Total number of bedrooms: _____
Is the property on a septic system? YES NO
*If yes and adding new bedrooms, a new or expanded septic system may be required. If a new system is needed, or the current system
needs expanded, you must have a contractor licensed with Polk County; complete the application for Onsite Wastewater Tre
atment
Disposal System. Please contact Public Works at 286-3705 to find out the requirements and capacity of your current system.
Additional information (if any): ________________________________________________________________________________________
Checklist of items to be filled out or complet
ed prior to submitting applicatio
n packet:
_____ Finished basement or inte
rior remo
del permit application and checklist
_____ Detailed floor plan layout drawing
-No construction shall start until the permit is issued.
-All work must be permitted prior to inspections.
-Unresolved Zoning, Subdivision, Floodplain, Health items may delay the issuance of any permit. No structure should be used or
occupied until the certificate of occupancy/use is issued.
--All electrical, mechanical, or plumbing permits must be applied for separately by a state licensed contractor.
Contractor/Owner/Applicant Statement:
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 Occupancy/Use is required in
accordance with applicable codes and ordinances.
I have included all of the above checked items and I understand that all the items listed above must be reviewed and fees paid before a
permit will be issued. I further understand that construction work cannot begin until the building permit has been issued. All information
supplied by me is true and correct, and to the best of my knowledge and belief.
I affirm I am the owner or licensed contractor of this property. I hereby acknowledge that I have read this permit and state that the
information is correct, and agree to comply with all ordinances and state and federal laws regulating activities covered by this permit.
*Please allow 5-7 business days for permit review and approval
____________________________________________ __________________________________________ _____________________
Print Name Signature Date
Permit #______________________
click to sign
signature
click to edit
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