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10/04/201,1 12:37 FAX 9529335049 CULLIGAN NNTRA Q003 <br /> ''�,. �PLL ��L��''�F:Il'�TG�I�T�'�A�,�SD .• <br /> FIXTURE BSMT 13T 2ND OTHER FIXTURE BSMT 1 ST 2ND 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 /> 1%1'� <br /> , h" (• ,15.1'^ jr�. r •r .��• �gr�,_• `d; "p y :. <br /> Mmu-4,0 <br /> hYes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Des not require modification to electrical or gas service. <br /> 2. Hasa total cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the 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 Next Page) <br /> . 2 <br />