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08/11/2015 14:18 FAY �5293a5049 CULLIGAN MNTKA C�003 <br /> , � i � <br /> 1 i � <br /> 1 h.,�u ��I��' �'1�,'� I.J,���Iu���1�:�����V���������J�'���Ytr..,��Vf"�������,7��r�A'v. .�� �, 4. ���:A.I..,' �.�%�,�,-(.�� ..`A. . . <br /> �D lJ�� �7�1����liL�1J'""� <br /> F17{TURE BSMT 1 2 OTHER FIXTURE SSMI' 7 2 OTHER <br /> TYPE �'1. F�- TYPE FL FL <br /> WaZer Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Loundry Tray <br /> Shower W asher <br /> iCitcl�en Sink Water Heater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> 5illcodcs Miscellaneous <br /> ���^n. �I I ' '' � +i.b, h'I'i'r �.Y..'i +�a y-,� ry �,�. �r , �,'ii Cn" F �l ��` � � ;�,/ <br /> 'j(�,.,.�� 1 �,jt� � i v.ci .i!�,,.1�' i��i . ��.�'f� �����Cl�'�J�r ��'� �., � i,:' C.��;�I'.. ,�.r�.�,i�� ' � <br /> '� I :VI���`.'� y` 1� ��� , :I]I�S��Vi."P �,Q��,�131��T���J�� �� �, ,"',�` � ;1 i i���i,,,x, <br /> �1` <br /> ❑ Yes,this seciion appIies <br /> The replacement of a Residential fixture or avAliance that meets all three of the following requiremenrs: <br /> 1. Does not require modification to electrica]or�as service. <br /> 2. Has�iotal cosr of$500.00 or less;excludin�the cost of the fixture or appliance:and <br /> 3. Zs improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next scction,if this appli�s; Cost ofPermit $ I5,00 <br /> State 5urcharge � S_�p <br /> Mail-In Fee(If rlpplicable) � 2.00 <br /> Total Pei•mit Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />