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08/19/2013 �4:18 FAX 9529335049 CULLIGAN MNTKA l�006
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<br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> TypE FL FL TYPE FL Fi.
<br /> Water Closet Fioor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener '
<br /> Dishwasher W�B�'
<br /> Sillcocks Miscellaneous
<br /> ^,j'k;ifn,iac• .��"i%' $rf'�'•�..�„'�.�r4fa �� �,� `� .i;�� �7.V'F�� i•'pe;1"���'���y'e�'�S���It'A-�h�l4�a r+i,
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<br /> ❑ Yes,this section appiies
<br /> The replacement of a Re idential fixture or appli�that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a total cos of$500.00 or less;excludin¢the cost of the fixture or appliance:and
<br /> 3. Is improved,installed or rcplaced by the homeowner or licensed contractor.
<br /> I Skip next section,if•this applies; Cost of Permit $ 15.00
<br /> , State Succharge $ 5•OQ
<br /> Mail-In Fee(If Applicable) 5 2.00
<br /> Total Permit Fee $
<br /> i(Permit Fees Continued On Next Page}
<br /> , 2
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