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07/10/2012 14:38 FAX 9529335049 CULLIGAN MNTKA 21003 <br /> • <br /> VAI:�,., ,... . .. .., .. V,.,O0 i .... .......,,.. '"!J:Y;;S:CI;'>'0:4P.. ,. <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 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 /> • <br /> dk.•. E nl, .� ' ai! F ° 9 I:���i � i�•' jl(:'lY�'• <br /> }�K '• �J ,.� � sl..r � �' !l�1117,='t i r r �J ' i`' ti 7. .044.t4'.744,5,-,,,a--4,476 ka ! IT <br /> 0gy x;tuaPu ,i . ?,w.:.. � <br /> Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> • <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 />