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 OwnerNumber 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: