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05/23/2016 15:31 FAX 9529335049 CULLIGAN MNTKA U003 <br /> S. <br /> n.."' ,•a,�„-'fry. .'�. ,,, (, r ;,;,,;::., <br /> FIXTURE 13SMT lsr 2ND OTHER FIXTURE BSMT �' 2ND 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 /> r�!,��1��''���lII,'"rr <br /> 'i'L�i�+ ,.,45 :'" ' <br /> .r..;,, .� �,r.,. ��ii�rl. ;,iv..,•V.('. �� ,'l� <br /> � !' I. Ir ,"I i��. ;( 'I•i;".,'I,'11�'r,�;,C'I,�p„;.i <br /> ''�ir.;,,, :1';,,,;,��:'a�'.,•� ,, . ., „ ��'Q� <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 />