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01/19 2015 1a:21 FAX 9529a�5049 CULLIG9N MNTKA �003 <br /> w � <br /> ;;viii�"�Mi��'1p�i�.� �'; ;;,, �v;�I..taR aF��L�11��,Ti'�i:r1��5:C,�3�D��llYl7'���ST�I:EaJ•� �T, ,�.� "(;:�;�."..,i '� : <br /> i �i:ici,.u ���i � "� i;� � �.a `M` ,;v .�j.�� <br /> FIXTURE BSMT 1' 2' OTFIER FIXTURE BSMT 1 2 OTI-iER <br /> TYPE PL PL TYPE FI. FL <br /> Watcr Closet Floor Drains <br /> Lavatory 5ewcr EjecSor <br /> Sathtub Laundry Tray <br /> Shower W ashcr <br /> Kitchen Sink Water Heatet <br /> l�isposal Water Softener � <br /> I, <br /> Dishwasher Wct Bar <br /> Sillcocks Miseellaneous <br /> ��I,.�rM1pl�"w����l�Vt�li�ih'�-.'�(�I"!r',r,!"i�r. �i°l�i"��:'1 : 4� - ,n;:'t`;:'nvn':y�.���'r•:y',,�"�'j�'�I��a�,,iH,na�m��n',1" "�'Ic��i <br /> �����ti�t�a!'µ�1� i' i N h��(�I � �( .Iw i �„ I� i> >� ,�,,(i � , tn� IM ���'�T�1' .�� <br /> � � �, � ���r,�;��r���,��c,A �o��� , � � � , ��� <br /> ���Fd � iJ� ��:l �i I� � II � I 1�' I �� 1 r � I i f , u` ��pG��:l�. <br /> ��f ��� :, '�s, � ��, ��,��s�������� ��a�a��s��A;�sT�,���� � � ��, � �� ���,� <br /> ❑ Yes,this section applies <br /> The 1'eplacement of e Residrntial fixture or a�pliance that meets a11 tliree of the following requi�ements: <br /> 1_ Does not require modification to electricaf or gas serviee. <br /> 2. Has a total cost of$500.00 or less;excludin�the eost of the fixture or applianee:and <br /> 3. Is improved,installed or replaced by the�iomeowner or licensed contraetor. <br /> 5kip next seCtion,if this applies; Cost of Permit $ 15.Op <br /> State 5urchargc $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit�'ee $ <br /> (Pcrmft I'ees Continucd On Next Page) <br /> 2 <br />