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08/11/2014 14:01 FaX �J52�Jaa504�J CULLIGAN BZNTI�A �003
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<br /> l=1XTUR� BSMT 1' 2 OTHER FIXTURE BSMT 1 2 OT!-ILR
<br /> TYP� FL FL TYPE FL PL
<br /> Water Closet Floor l7r�ins
<br /> Lavatory Sewer Ejector
<br /> Bathrub Laundry Tray
<br /> ShoweC Washer
<br /> Kitchen Sink Water�-Ieater
<br /> Disposal Water Sofiener �
<br /> Dishw35her Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> ❑ Yes,this section applies
<br /> The repl3cement of a Residenti�]fia-ture or appliance that meets all three of the folfowing requiremenTs:
<br /> 1. boes not requiro modifieation to electrical or gas Service.
<br /> 2 Has a total cost of$SOO.QO or less;exc�g the cost of the fixture or applianee: and
<br /> 3. Is improved,installed or rcplaced by the homeowncr pr liecnsed conTraetor_
<br /> $k!p next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5_00
<br /> Mail-In Fee(Tf Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> (Permit Fees Continued On Next Page)
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