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07/12/2011 13:51 FA% 9529335049 CULLIGAN MNTRA l�003 <br /> ��<; :�� '�; . �-.�I��� � �•�.'T�.'�'',r,:�'L'�.�`T.U.A:L�'��1�r�3�1�T�F�T?' � . . <br /> FIXTiJRB BSMT 1 2 OTHER FIXTURE BSMT I 2 OTHER <br /> TYPE FL FL TYPE 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 /> ti'' ' �,k ,�; �� — ;�! ��. � ��t • <br /> y trus� ,� �. .� :;:e ��:.k4.�,�:�y�, p : <br /> -'.t ,.5�.•w9 'j•��i�i.�' !a . �»' r�� <br /> Yes,this section applies , <br /> The replacement of a Residential fixture or aogliance that meets ali threc of the following requiremcnts: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total co of$500.00 or less; xc ud' the cost of the fixture or appliance:and . <br /> 3. Is improved,installed or replaced by tho homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Ne�ct Page) <br /> 2 <br />