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11/25/2014 13:34 FAX 9529335049 CULLIGAN MNTKA ll003
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<br /> FIXTURE ESMT 1'r 21ND OTHER FIXTURE BSMT 1ST 22ND OTHER
<br /> TYPE FL FL TYPE FL FL
<br /> Water Closet FIoor 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 a Residential fixture or appliance that meets all three of the following requirements:
<br /> 1. hoes not require modification to electrical or gas service.
<br /> 2. Has a tQta1 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 />
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