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12/11/2014 14:35 FAg 9529335049 CULLIGAN MNTKA f�OOa
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<br /> FIXTURE BSMT 1 2 OTHER plXTURE �SMT 1 2 OTHER
<br /> 7yp� FL FL TYPE FL FL
<br /> Wetet Closet Floor Drsins
<br /> C,avatory Sewer Ejector
<br /> $athtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> pisposal Wster Softener
<br /> Dishwasher Wct Ber
<br /> Sillcocks Miscellaneous
<br /> a e .�PMp J ' � 7.� o iC,� �7y �,.a�1 '" ,/,�r�yy�+ �"�F;�' ''�ry � .� �F�;.,�5�,,'i:yr;�yil�'„'
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<br /> ''ii'IY�Y"��",.�"r� •�� 1�;1�;; W ��i�. .. r,''�i;l'�'�^9�I"i�;4;t��:�;� d�
<br /> �'�1°c1'�H'�b�i.;�`.dJ ,��li;:�t ,.r�y��v.��J.+il'Y',��i���F��U�4Y��L+(�'i�d-!;•'47T�+•�ir�"�,f ,i.:� ��i• � �!P',�k+'
<br /> � � 'Yes,this scction applies
<br /> 'Y'he replecement of a itesidential fixture or aou iance that meetS sll three of the following requirements:
<br /> 1_ Docs not reyuire modification to cleetrical or gas servicc.
<br /> 2. Hes a total co of$500.00 or less;exc udin the cost of the flxR►re or applianae:snd
<br /> 3. Is lmproved,installed or replaced by the homCowner or liCens�l contractor. •
<br /> Skip ncxt section,if this applies; Cost of Permit $ 15.00
<br /> State S�ch�ge $ 5.09_
<br /> Mail-In Fee(Yf Applicablc) $ 2_00
<br /> Tatal Perrnit�'ee S
<br /> (Permit�'ees Continued On Next Page) .
<br /> 2
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