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11/30/2009 11:11 FAX 9529335049 CULLIGAN MNTKA l�003
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<br /> FIXTURE BSMT 1 2 OTIIER FIXT[JRE BSMT 1 2 OTF�R
<br /> i 'rypE FL FL TYPE FL FL
<br /> � Water Closet Floor Drains
<br /> ILavatory Sewer Ejector
<br /> athroom Laundry Tray
<br /> Shower Washer
<br /> Kitc�en Sink Water Heater
<br /> DispPsal Water Softener '
<br /> DishNvasher Wet Bar
<br /> Sillcpcks Miscelianeous
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<br /> � Yes,this sectian applies
<br /> The feplacement of a Residential fixture or appliance that meets all three of the following requirements:
<br /> � 1. Does not require modification to elactrical or gas service.
<br /> ' 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appiiance: and
<br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor.
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<br /> j Skip next section,if this applies; Cost of Permit $ 15.00
<br /> � ' State Surcharge $ .50 .
<br /> Mail-In Fee(If Applicable) $ 1.50
<br /> I Total Permit Fee �
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<br /> (Perfnit Fees Continued On Next Page)
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