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05/08/2012 12:57 FAX 9529335049 CULLIGAN NNTRA 16003 <br /> FIXTURE BSMT 1 2ND OTHER FIXTUREY BSMT In 2 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 /> M. ,M— OhM& <br /> { y' <br /> Yes,this section applies <br /> The replacement of a Residential fixture orr appliance 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; it 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 $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />