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03/12/2014 11:59 FAX 9529335049 CULLIGAN KNTKA Q003 <br /> t<" '`.w, _ :,'):Jri•y�+l�1:`.' frj y}�� T }Jy.,•, :'i 777 <br /> •,.Y.a:�:, <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT I15T 2w- 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 1 <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> a tt�.,}�.+5�-:*�i •+ti.7�;..:Ykif.�''s,ice'-i 4'�';'�.�'�k",;. .l: "'4 _� ". 'a �3'„79�i:.��”-"'s 'gW,:' � .+¢.w�4o-' •' <br /> nyr.r'`�� r;u4!Eif .fi,•;�'}i. ,r,: n �.Wf:, W .. .` '�}, � t.,w,....f. .13,ru('11,hFy x.a�li;w <br /> .i,.. `iX4R•. :�`i'G5r"' 'f st��,.•,`.�,.".•�,,�:` ::f t 5�`�ra'�.go,�' ;1i1";k r ,�.'�a.��'',n', '`. - <br /> • �_�,,..,..%5�.:.•.! �,��}:�. .i ice+ <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fi re ora liance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a 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 I <br />