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12/14/2015 14:05 FAX 9529335049 CULLIGAN MNTKA [2006
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<br /> FIXTURE BSMT 1ST 2Nn OTHER FIXTURE 13SMT 1" 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
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<br /> ❑ Yes,this section applies
<br /> The replacement of aAesidenrial 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 S
<br /> (Permit Fees Continued On Next Page)
<br /> 2
<br />
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