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09/1B/2012.13:01 FAX 9529335049 CULLIGAN MNTRA Q003 <br /> j,� r�,'s.y," g?C''��i's`'h�'jy' i !•�$'Y'..'y til'•+*_. <br /> -�-r^J".i5,.is�•:-1� ��.'g:. •a i {,^p'-ri�'.,i�•�.1: .'.�•`•.%:ai',;,dYY` <br /> FIXTURE BSMT lu 2 OTHER FIXTURE BSMT Vr 1m 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 /> Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Hasa total co of$500.00 or less;excludin 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 />