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09/09/2014 14:12 FAX 9529a35049 CULLIGAN �NTKA I�OOa
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<br /> F]XTURE BSMT ) 2 OTHER FIXTURE BSMT l 2 OTIi�R
<br /> TYPE FL FL 1YPE FL �'1,
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink WaterHeater
<br /> Disposal Wat¢r So$ener �
<br /> Dishwasher Wct Bar
<br /> 5illcocks Miscollancous
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<br /> ❑ Yes,this section appli�s
<br /> The replacement of a Residcntial fi re or A liance that meets all three of the following requircments�
<br /> 1. Daes not require modification to electrieal or gas serv;ce.
<br /> 2. Has a Cotal cast of$500.00 or less;excl in the eost of the fixture or appliance:and
<br /> 3. Is improved,installed or replaccd by the homeowner or liaensed contractor.
<br /> Skip next seCtlon,if this applies; Cost of Permit $^ 1�_.00
<br /> State Surch2rge $ 5_00
<br /> - Mail-In�'ee(If Applicablc) $ 2.00
<br /> , Total Permit�'ee $
<br /> (Pernnit Fees Continoed pn Next Page)
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