City of Appleton
100 North Appleton Street, Appleton, WI 54911
Phone: (920) 832-6411 Fax: (920) 832-6464
HEATING - VENTILATING - AIR CONDITIONING PERMIT
Permit No.
Key No.
Receipt No.
Date
Permit Fee: $
Penalty Fee
TO THE HVAC INSPECTOR
:
I hereby agree, with the issuance of this permit to do only the work specified herein and to faithfully comply with the laws and regulations of the State of Wisconsin and the ordinances of the City of Appleton.
Customer Number (if applicable):
Name of Owner
Number and Street
Type Of Building
Type and Quantity of Installation
One-Family,
New
Sq Ft*
One Family Remodel
Air Conditioning, Res.
Oil Boilers
Two-Family,
New
Sq Ft*
Two Family Remodel
Air Conditioning, Comm.
Rooftop
Multi-Family
Heated Garage, Res.
Air Handlers
Unit Heaters
Commercial, Industrial
Gas Boilers
Oil Furnace
Other (specify):
Gas Furnace
Stove/Fireplace, Res.
Other (specify):
*Square footage based on all floors and basement, garage separate
State Approved Plan Required:
Air Conditioning Electrician:
Total B.T.U.
Heating:
(List in B.T.U.'s)
Air Conditioning:
(List in B.T.U.'s)
Estimated Cost(s):
**Note: Cost of Heated Garage Res, AC Res, or Fireplace Res only
Call 920-832-6411 for all required inspections.
Contractor Information
Name of License Holder:
City License No.:
HVAC Contractor:
State HVAC Certification No.:
E-Mail Address:
Daytime Telephone No.:
Contractor Mailing Address:
City:
State:
Zip:
I agree that this permit is not valid until an approved permit is e-mailed back to me. Permit fees are non-refundable.