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O1/14/2014 13:46 FA% 9529335049 CULLIGAN �NTRA C�003
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<br /> FTXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> TYPE FL FL 'FYPE FL FL
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub T,aundry Tray
<br /> Shower Washer
<br /> Khchen Sinlc Water Heater
<br /> Disposal Water Softener r
<br /> 1
<br /> Dishwasher Wet Bar
<br /> Sillcocks Misccllanaous
<br /> 4� • F .
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<br /> .Y'a'Y,�. ..id"`�Y!i' t%w'..n
<br /> �f Yes,this section applies
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<br /> The raplacement of a Residential fixture or appliance that meets all three of the following requirements:
<br /> 1. Does not require modification to eiecirical or gas service,
<br /> • 2. Has a total cast 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•60
<br /> State Surcharge � S.QO
<br /> Mail-In Fee(If Applicable) $ 2,00
<br /> Total Permit Fee $
<br /> (Permit Fees Continued On Next Page)
<br /> 2
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