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11/0$/2015 11:28 FAX 9529aa5049 CULLIGAN MNTK� f�00a
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<br /> FIXTLRE
<br /> BSMT 1' � OTHER FIXTURE �SMT 1, '/2 . OTHER
<br /> �ypE FL FL TYPE FL FL
<br /> Water Closet Flo or Drains
<br /> Lavazory Scwcr�jector
<br /> Bathtub Laundry Tray
<br /> Shower W asher
<br /> Kitchen Sink WSIeY E�eateT
<br /> Disposal Water Softener I
<br /> Dishwasher Wet Sar
<br /> 5illcocks Miseellaneous
<br /> .1 „F'rlp(lyr,.��::;��h:-r,>.,a;;��;,u,r,.,�r.�;� ;„�a�,7y �j, y�y v('� 7�'7� [1 /:;: 4;1��'.�:hC;l�a;:i)•...�,A.,��?ak,� .;d��f
<br /> �I,�(r,�.���:SAM�.��� �� i �I:'� ,� 4� �P',C���iI'." Jl.:i `,<'��.-�-�,�l�l1i1 Q��Q� ,^ r�7 ^ � �q �
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<br /> �� y�es,this scction app�ies
<br /> The replacemcni of a ftesidential fixture or apAliance that mects�11 thPee of the following requirements:
<br /> 1. Does not require modlficaiion to electriCal or gas service.
<br /> ?. Has a rotal cost of�500.DD or lcss;excl in ti�e cost of the fcxture or applianee:and
<br /> 3. Is improved,installed or rcplaeed by the homeowner or licensed contraetor.
<br /> Skip next soct�ion,if this applies; Cost of Permit $ 15,Q0
<br /> State Surchargt �_ 5.00
<br /> Mail-In Fee(If Applicable) � 2.00
<br /> ToYal PCrmlt�'ee $
<br /> (Permit FCes Continued On Next Page)
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