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06/14/2016 08:57 FAX 9529335049 CLiLLIGAN MNTRA C�003
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<br /> FIXTURE BSMT 1 2 OTHER FIXTLTI� BSMT 1 2 OTHER
<br /> TYPE FL FL TYPE FL FL
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower W ashtr
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener �
<br /> Dishwasher W�$�
<br /> Sillcocks Misccllaneous
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<br /> ❑ Yes,lfiis soctian applies
<br /> The replacement of a Residential frxture or appliance that meets a11 three ofthe following requirements�
<br /> 1. Docs not require modification to electrieal or gas service.
<br /> 2. Has a Cotal cost of$500_00 or less;excludine the cost of tho fixt►uc or appliance:and
<br /> 3. Ys improved,installed or rcplaccd by the homeowner or licensed eontractor.
<br /> Skip ncxt section,if this applies; Cost of Permit $ ]5.00
<br /> State$urcharge $ 5_00
<br /> Mail-In Fce(If Applicable) S Z.00
<br /> Total Permit Fee $ '
<br /> (Permit Fees Continued pn Next Fage)
<br /> 2
<br />
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