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 plumbing 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: ___________________________________________________
Plumbing 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
PLUMBING 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:
Number of fixtures roughed in for and/or installed: __________ ($7.00/fixture, $50.00 minimum permit fee)
Application is hereby made to do the above-described plumbing work at the premises named above.
Issuance of the permit is based on §145.06(4)(a) of the State Code allowing a property owner to
perform plumbing work in a one-family building owned and occupied (per SPS 382.10(2) of the State Code)
by him or her as his or her home.
AFFIDAVIT: I hereby certify that I am the owner of the above-described 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 plumbing 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.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
