Site Address of Project: Click here to enter text.

Permit #: Click here to enter text.

What “Trade” and “Inspection Type” are you requesting?

TRADE	Inspection Type
☐ Structural (S)	Choose an item.
☐ Electrical (E)	Choose an item.
☐ HVAC (H)	Choose an item.
☐ Plumbing (P)	Choose an item.

If selected “Other” (above), please explain:

Click here to enter text.

When would you prefer to have your inspection?

Click here to enter a date.	☐ AM (9 AM-11:30 AM)	☐ PM (12 PM-3:30 PM)

CONTACT PERSON ☐ (if same as CONTRACTOR)
Name:	Click here to enter text.
Phone #:	Click here to enter text.	E-mail:	Click here to enter text.
CONTRACTOR
Business Name:	Click here to enter text.
Phone #:	Click here to enter text.	E-mail:	Click here to enter text.

** Please be aware that an inspector will contact you to confirm the time and date of the

requested inspection. If you have any questions, please call the

Winnebago County Building Division at #815-319-4350. **