Two-Family
NATURE OF WORK (check all that apply):
Swimming Pool
Alteration
Remodeling
Repairs
Sign
Addition
Detached Garage
Hot tub/spa
Other ____________
JOB DESCRIPTION:
(REQUIRED)
_______________________________________________
Signature (Master Electrician Responsible For Work)
(REQUIRED)
___________________
Date
INSPECTOR STATEMENT: I hereby certify the work completed as of date signed complies with applicable codes.
____________________
Date
_________________________________________________
Inspector Signature
This section for City use only
Project #:
Permit Code:
Permit Fee:
Parcel #:
Receipt #:
Date:
Department of Community
and Economic Development
100 N. Jefferson Street, Rm 608
Green Bay, WI 54301-5026
(920) 448-3300 - phone
(920) 448-3426 - fax
inspmail@greenbaywi.gov
LICENSED CONTRACTOR
ELECTRICAL PERMIT
APPLICATION
Check box for Online Payment
The information below must be provided for notification of project number and permit fee. This information is
required to make payment on-line.
Educational
Other
Multi-Family
Number of Units
Manufacturing
Phone _________________
Fax ________________
________
To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one
business day in advance. Final inspections are required for all projects.
CONTRACTOR STATEMENT: I hereby certify that the above wiring upon completion will be in compliance with
the applicable federal, state, and local electrical codes and utility service rules.
“ENERGIZING THE DESCRIBED WIRING WILL IN NO WAY CREATE A HAZARD”
State of WI Electrical Contractor Certification # _____________ and WI Master Certification # _______________
Email ____________________________
(Rev 6/20)
www.greenbaywi.gov
All fields must be completed before permit will be processed.
Project Address: __________________________________________________
Owner's Name: __________________________________________________
Owner's Email: Phone #:
Electrical Contractor: ______________________________________________
Contractor's Address: ______________________________________________
Contractor’s Email: ________________________________________________
Contractor’s Phone #: ___________________ Cell #: _____________________
Value of work: ___________________________________________________
Single-Family
Commercial
OCCUPANCY (check appropriate box):
click to sign
signature
click to edit
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click to sign
signature
click to edit
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