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10/0 L`2010 15:10 FAX 9529335049 CULLIGAN MNTKA �003 <br /> _ • ' <br /> t.�*nj(= .FfH' 'i nl= ;L`�i•:'�.; : f. ,��G1� ,. n� •i••; �r;,: <br /> �.i.: :,r• �y ro.�r,_.�f�: �i �t3'i7►7�. ���:�'�'',�..�fv.i i'.Y;��f,��;4a.. <br /> y�. <br /> F[XTURE BSMT 1 2 OTHER FIXTURE BSMT ] 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains ' <br /> Lavaiory Sewer Ejactor <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softaner <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 4,, � <br /> ` A <br /> � '' �I <br /> Yes,this section applies <br /> The replacement of a Residential fixture or apeliange that meets all three of the following requirements: <br /> 1, oes require modification to electrical or gas servica. <br /> 2. Has a total cost of$500.00 or less;excludins the cost of the fixture or appliance:and -�"�� <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next scetion,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5•00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Tota!Permit Fee $�_d� <br /> (Permit Fees Continued Oa Next�age) <br /> 2 <br />