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07/16/2012 14:37 FA% 9529335049 CULLIGAN MNTRA 1�003 <br /> ._ _. .. . . '--- �-� . . <br /> a, ' .,::��,�'y'`�,.��-`-T%„ .1; �..o,o,. <br /> H, .:1�'t• <br /> 3- "��r'.Ia .,�''� ✓'. '-b�'.. }�' <br /> •�i il �'�' `�. {td.^�if� a �::r.Y_.-�.�r � <br /> FIXTURE BSMT 1 2 OTHER PCXTURE HSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL . <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> g��b Laundry Tray <br /> Showcr W��' <br /> Kitchen Sink Water Heater <br /> Disposal ater o ener I <br /> Dishwasher Wet Ber <br /> Sillcocks Miscel►aneous <br /> ! � z� <br /> t <br /> Yes,this section applies <br /> � The replacement of a Residential fixture or anplianc�that moets all thrce of the following requirements: <br /> 1. Does not require modification to electrical or gas servica. � <br /> 2. Has a total cost of SS00.00 or less;�xciudinE the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeovmer or licensed contractor. <br /> . Skip next section,if this applies; Cost of Permit S 15. <br /> State Sutchazge $ 5.00 <br /> Mail-In Fce(If Applicable) $ 2.00 <br /> Tatal Permit Fee S <br /> ` (Permit Feee Continued On Next Page) . � � <br /> w <br /> . � <br />