www.greenbaywi.gov
___________________________________________________________
Owner’s Signature
_____________________
Date
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.
The City of Green Bay hereby permits the above-described heating work to be performed at the
address stated above, subject to all laws and regulations of the City of Green Bay and the State of
Wisconsin.
By: __________________________________________________
Heating Inspector
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
HOMEOWNER’S
APPLICATION FOR
HEATING PERMIT
This section for City use only
Project #:
Permit Code:
Permit Fee:
Parcel #:
Receipt #:
Date:
(Rev 6/20)
All fields must be completed before permit will be processed.
Name:
Address:
Phone #:
Email:
Value of Work: $
Description of work:
Application is hereby made to do the above-described heating work at the premises named above. Issuance
of the permit is based on SPS 305.70 of the State Code allowing a property owner to perform heating
work in a building owned and occupied by him as his home.
AFFIDAVIT: I hereby certify that I am the owner of the above-named premises located in Green Bay,
Brown County, and that I occupy such premises solely as a residence in accordance with the
Homestead Act of the laws of the State of Wisconsin. I further declare that if the permit is granted
the heating work will be performed by myself in accordance with State and City regulations.
Failure to do so will subject me to penalties described in the State and City Ordinances.
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