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09/20/2011 14:09 FAX 9529335049 CULLIGAN MNTRA I�003 <br /> �M+ I <br /> � . - .•PL��TG:�:;�. � _` �S�'$�11�C'ar��ST1k�i��D � • . . <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL 7'YPE 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 Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �� ; ,p '�." ��'r� , . it� '��y�� ��1.: • .e. E <br /> '� '��1�"^F� '�1`l. 5' �' t: i 7"7:. A <br /> 7� a '�x�J1 �: � �r y". n��'i'r�� <br /> y � <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or ag I�that meets all three of the following requiremcnts: <br /> l. Does not require modificetion to electrical or gas service. <br /> 2, Has a ta c of$500.00 or less; cl ' the cost of the fixture or applience:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> � Skip next section,if this applies; Cost af Permit S 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fce(If Applicable) $ 2.00 <br /> Totel Permit Fee S <br /> (Permit Fees Continaed On Next Page) <br /> 2 <br />