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04/15/2014 12:09 FAX 9529335049 CULLIGAN NNTKA Q003 <br /> Lom <br /> :. - <br /> FIXTURE BSMT 1 2 N11 IOTHER FIXTURE BSMT 1 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 /> '•,'�;15�SYf�":"�."a�,i '�� t:.:l' ,r�{u �f :s'.i �''+'�''w3•� -�d:�-:Ch_ ,a iYjr <br /> t'�' �''',,,t',{,`-v:.1-, ':$rr69:t 3;NE,c�,rrk�,� y,:�. t""' :t4!? :��t"�'•"." '� �yr S,,':,�- <br /> pnntuh, it�.'+,_v:.;{.;.�, syfi7, ina:e.. .�✓{ '4• _ '.�.... .4 krfteryn„'�.,•,n.uw;. �.S`'S.k�}' h1ti�•i,.•iu- <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. 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 $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />