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12/22/2014 1�:4� FAg 9529a35049 CULLIGAN bINTKe1 f�003
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<br /> FIXTCTRE BSM7' 1 2 QTHER FIXTURE $SMT I 2 OTHER
<br /> TYPE FL hL TYPE FL FL
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Baihtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink VVater Heater
<br /> Disposal Water Sof�enor
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> „i.
<br /> ❑ Yes,this seccion applies
<br /> The replacement of a Residentia)fixcure or sQpliance that mccts all three of the following requirements:
<br /> 1. .Does not require modifieation to cicctrical or gas service.
<br /> 2. Has a total cost of$544.00 ar less;excludine the cost of the fixture or appliance:and
<br /> 3. IS improved,installed or replaCed by the homeOV►mer or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) � 2.00
<br /> Total Permit Fee �
<br /> (Permit Fees Continaed Op Nerct Page)
<br /> 2
<br />
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