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04/19/2016 10:32 FAM 9529335049 CULLIGAN KNTKA Z009 <br /> "w�;"4,�,,a1',; .ir' �;.,, ,''' 1 Vii„" ` ES;�3EIIt1 '• IS,, �' ;,''' ,;,;�;• I <br /> FIXTURE BSMT 151, 2ND OTHER FIXTURE BSMT 11T 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �.,..,pN;T'w�3.R�{�.r4!Yip.yS7:;Y.;��%f.��`i+t'•11^TI� , F�„+�'j',",,'1. r�' I�'i ',�;��� ''�l..:I,,"�+!(?k:��;.�:.1�1;I r r;;�I�•'^i�;� <br /> r. <br /> ,IQ,,'J4,�rg ',is ii''•;�, ;.� a <br /> '.� '''";`•'`u;i'l 1f�'p,''li'` �L' ".r: "•l'�vC'.'I��''AL3,%YAJ.J��:00VU's <br /> 7T6l..f.l2. 1�1.i -,;;tr:' a,;%tq� �"1-,; I• I',,,;,p,:'qv,'r•, <br /> i� <br /> "-C �A .ro; �. 5% °•I'�,i 4r..•r 'ice <br /> ❑ Yes,this section applies <br /> The replacement of a residential fixture or appliance that meets all three of the following requirements; <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Hasa total cost of$500.00 or less;excludinE the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee Of Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />