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09/23/�010 11:59 FA% 9529335049 CULLIGAN MIVTRA I�003 <br /> ;r.,9 ,i a;am. _ '�� r��.x�{��c� :.�;.'R•`.: •.,-;,;:. <br /> .r� �;:.�F�.',�'•':}� ..�•� ��:!:�'�> s x .� +' ��'•' '}?'�+Lli?�M'i.i� -;{�':{?�:i• -•�..;..;:a. <br /> FIXTURE BSMT l 2 OTHER FIXTURE BSMT l 2 OTf�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Levatory , Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Sottener I <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � , <br /> , i... 1`• �`',.= "t <br /> � Yes,this section applies <br /> The replacement of a#tesidential fixture or aR I�ig{�ce that meets al!three ofthe foilowing requiraments: <br /> 1. Does not require modification to electrical or gas sorvica. <br /> 2. Hes a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. is improved,instelled or replaced by the homeowner or licensed contractor. <br /> Skip aext section,if this applies; , Cost of Permit $ 1 s.00 <br /> State Surcharge � 5.00 <br /> Mail-In Fee(lf Appliceble) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Contiaued On Next Page) <br /> 2 <br />