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O1/08/2014 13:07 FAX 9529335049 CULLIG9N MNTKA �003 <br /> f <br /> "'' '1���TNIDT�7�'r�I�"TCJR�S`�3E1NG;71�J�'t'AL:T��D - <br /> .�.t <br /> FIXTURE BSMT I 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatnry Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener I <br /> l <br /> Dishwasher Wet Bar <br /> Sillcceks Miscellaneous <br /> r��`���,;��`�,s��j,�r'r�~� � , µ P�R.�T�'E�CALC�[:7I:ATI�7N(� �t�'����a � �� ' �`4=�� ���x�: <br /> a �r� ��;�. �, r.r�ts�",�. . � � I3A;�'ED CUF�':—.2Q02 STA'TE STATUE. ;'w�'ca�;�'= �� '�, ��`',''�}fi�:;$�� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or agpliance that meets all three of the following requirements; <br /> 1. Does not require modification to e]ectrical or gas service. <br /> 2. Has a 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,ifthis applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5,00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />