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09/15/2015 12:07 FAX 9529335049 CULLIGAN M=A Z003 <br /> � 9 <br /> J:11,1'�'' ''r`•J�! .'��.,�;'��;�,,���.���.' r �,t`'7`��L"f11'V•�' �ilS���l7i'll`l0-•L`��' � 1�',': '� ,_;�,.. <br /> FIXTURE BSMT 1 2ND OTHER FIXTURE I BSMT 1 2 OTHER <br /> TYPE FL l;l. TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Neater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcoeks Miscellaneous <br /> ;""l� <br /> ' a:" "°v,:'r.✓•!„+ ,. :P.,1. �y� 1 1 @,.i•., „i'''r'•:�1,a..�qP;r ..y,"hr„.' jdl <br /> 1 I-rfq;, ” ,1, .'•{ei�C',G y, <br /> .�� 1• •1 wr :! .11 •,(r' 3 'n i 1. <br /> 41. I :.1;' ;'ll. "f ,'� �1"irN��1,1141`xfi i•4. <br /> Yir', ; ;,.,>;'',; „i,; "�•;,;1; ' BE 'QSjA 'C3 <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 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 /> Sldp 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 $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />