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10/18/2010 13:32 FAX 9529335049 CULLIGAN NNTKA Q003 <br /> r.'ds`,+ :i •.' '8 ,'1C: `» 11-71FE%10 MID wil-M-M <br /> �1r . r'7,'.•:ri i', •, ;irx:J <br /> FIXTURE' BSMT IST 2 OTHER FIXTURE BSMT l 2NO 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 no require modification to electrical or gas service. <br /> 2. Hasa total cost of$500.00 or less;e c udin 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 Of Applicable) $ 2.00 <br /> Total Permit Fee S <br /> '1 <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />