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<br /> 04/19/2016 10:�1 FA% 9529�a5049 CULLIGAN M1VZ'KA C31003
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<br /> FIXTURE BSMr 1 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> TYPE FL FL T'YPE FL �'L
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bsthtub I,aundry Tray
<br /> Shower W�6�
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Sottener .(
<br /> Dishwesher W�g�
<br /> Sil lcocks Miscellaneous
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<br /> ❑ Yes,this section appiies
<br /> The replacement of a ReSidential fixture or appliancc that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas serviee.
<br /> 2. Has a total cost of SS00.00 or less;excludine the eost of ihe fixCure or appliancc:and
<br /> 3. Ts improved,installcd or replaced by the homeowner or licensed contraetor.
<br /> Skip next section,if this applies; Cost of Permit $ ]5.00
<br /> State Surcharge S 5.00
<br /> Mail-In Fce(If Applicable) $_�
<br /> Tot�l Permit Fee $
<br /> (Permit Fees Cootinaed Qr�Next Page)
<br /> 2
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