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05/O�i2016 09:33 F�fi 45293a5049 CULLIGAN MNTKA C�009
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<br /> FIXTURE BSMT ] 2 OTHER �17tTURE BSMT 1 2 OTHER
<br /> TYPE FL FL TYPB FL FL
<br /> Watcr Closet �'Ioor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> I�itchen Sinl: Watcr Heat'er
<br /> Di5po5a1 Water So$encr �
<br /> Dishwasher Wet�ar
<br /> Sillcocks Ufisceilaneous
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<br /> :�(���•„� ,, . + ,�, '� ,,' ` ' � �A`SBI�fl�F. �4D2�SZ'AI'�STATUE � � :�-� � �� , � .;,; �°
<br /> ❑ Ycs,this section applies
<br /> The replacement of a eside tial fixture or a liancc that mccts all thrc�of the fol)owing requirements:
<br /> ]. Does not require modification to eleettical at gxls secvice.
<br /> 2. Has a total eost of$500.00 or less;excludin�the cost of the�i�cture or appliancc:and
<br /> 3. Is improved,instAlled or replaced by the homeowner or Iicenscd contracCor.
<br /> Skip nea�t section,if this applics; Cbst of Permit $ ]5.00
<br /> State Swcharge $ 5.00
<br /> Mail-In Fcc(If Applicable) $ 2.00
<br /> Totsl Permit Fee S
<br /> (Permit Fces Continued dn Next Page)
<br /> 2
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