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__ 04!1�i2016 10:a1 FA� 95293a504� CL�LLIGAN MNTKA [�006
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<br /> '��u.. ,, �,-�.rs:>•<<'.�.,' `;.`;.," ' ,'`PLr1'il�I�iNCrk'I�kES B�TNG'�V�'Y':b,I.;L�p� �"
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<br /> FIXTURE �SMT J 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> �'�Y'PE FL FL 1"YP� FL FL
<br /> W ater Closet Floorl7rains
<br /> Lavatory Sewer�jector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink 'Water Heater
<br /> Disposal 'Water Sofrener
<br /> Dishwashcr Wet�ar
<br /> Sillcoeks Miscellaneous
<br /> �i.��.��f.�;.—i��.�Ap.i�l;���r�d:1. :��e`.�_�iM:,;r. ����.rl��� d .IY .rv�l�� �� !,Ir'!"'�":I�i rql"` ',�e"1Pr;,`.j�;I�yi�i�I,.M1�,:� �����,�,�;ii��
<br /> .,�.�� ,� � , �,� �, �,. �� ,,�� �`,� �'���, T„���_ �Ta_ "��ATxO�;�C��, . ; ..7,,���,�. ; , �,�-,u,
<br /> •�J, 7 j >p i � % i I ���... � � � �. �i� ��� i�1 i 111��
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<br /> ❑ Yes,this stction appli�s
<br /> The replacement of a}Ze�idential flxtUre qr analiance that meets alI three of the following requirements:
<br /> 1. Docs not requ'ue modification to electncal or gas serviee.
<br /> 2. Has a total eos�of$500.00 or less;exeludina the cost of the fixture or appliance:and
<br /> 3, ls improved,installed or replaced by the homeoumer 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.OQ
<br /> Total Permit Fee �
<br /> (Permit Fees Continued On Next Page)
<br /> 2
<br />
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