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05/26/2016 15:34 FAX 9529335049 CtiLLIGAN MNTRA 1�003
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<br /> FIXTLTRE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTH�R
<br /> TYPE FL FL T'YPE FL FL
<br /> Water Ciosei Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub La�mdry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener �
<br /> Dishwasher Wet Bar
<br /> Sil)cocks Miscellaneous
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<br /> ❑ Yes,this scction applies
<br /> T'he replacement of a Residential fixture or appliance that meers all three of thc following rcquirements:
<br /> 1. Does not requue modification to electrical or gas service.
<br /> 2. Has a total cost of$500_00 or less;excludine the cost of the fixture or appliance;and
<br /> 3. Is iraproved,mstslled or replactd by the homcovmer or licensed con�actor.
<br /> Skip next section,if this applies; Cost of Permit $ 15•OQ
<br /> State 5iucharge � 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Perm�t Fee S
<br /> (1'ermit Fees Continued Qe Ncxt page)
<br /> 2
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