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1L06/2015 11:28 FAX 952��35049 CULLIGAN MNTKA �006
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<br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 � Z OT�ER
<br /> TYPE FL FL TYPE FL FL
<br /> Water Closct Floor Drains
<br /> Lavaiory Sewer Ejector
<br /> Bt�thtub Laundry 7"ray
<br /> Shower W asher
<br /> � Kitchen Sink Water Heater
<br /> Disposal Watcr Softener �
<br /> Dishwashcr j Wet Bar '
<br /> Sillcocks Miscellaneous
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<br /> ,,.,��_�;;'I�;"':',.�;v ,' �'+ '��:�, � '� ..��'SED O�'F' „200?.,�TA�TE'S'Z'���TC7� �"' '� "` �'+;;, ,, � �",;
<br /> , Yes,this section applics
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<br /> The rcplacement of a Residential fik�ture or apvliance that meets all fliree of l'he follqwing requirements:
<br /> 1, Does not require modi�ication ta electrieal or g�service.
<br /> 2. Has a tot c st o�'$500_00 or less;exclu 'n the cost of the fix[ure or appliance-and
<br /> 3. Is improved,installed or rtplaeed by the homeownor or licensed contractor_
<br /> Skip next section,if this a�pIies; Cost of Permif � � _1S�
<br /> 5tate 5urcharge $ 5_00
<br /> Mail-In Fee(If Applic�ble) $ 2.00
<br /> Tota1 Permit Fee S
<br /> (Permit�'ees Continued On Next Page)
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