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01/1Q/2012,14:29 FAX 9529335049 CULL I GAN MNTKA <br /> • <br /> • <br /> v -0.044010020.=:fNlilieVehi.474a: <br /> FIXTURE BSMT 1sT 2N° OTHER FIXTURE BSMT 15T 214D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal ' <br /> ^ Water Softener 00 <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 1,411'; 12g. <br /> "tri, t-mf:--'• * ;Pt,' 7 Z' ••• <br /> ,170: -.:1;0:4'41741kIligi41144aCi,iNlat,9.:02Pli-`0,,r1;:itJ.PW.tt.t.Vie.lvifiloific4,444,,44154VM'l <br /> 1Z) Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. - <br /> 2. Has a total cost of$500.00 or less;excluding 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,if this applies; Cost of Permit $ -- 15.00 •• <br /> State Surcharge S 5.00 <br /> Mail-In Fee(If Applicable) $ — • 2;00. <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2• <br /> ti,, <br />