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10/07/2010 08:32 FAX 9529335049 CULLIGAN MNTKA �003 <br /> � . <br /> ; �<:,,�� ';t�;:.tw�;°;s �'L�:i'I�G.�I�U.��,BE�tG-�1�?STAIiLED <.�. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 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 I <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ,�w � �.'�d; ,ta�! y �F�i ,. i �rP , '�*� ul'll�, i"aX�r��rs..w dL�'il4$� �p rt � <br /> ��ia �� �"t��r`,�'#��;1°a gq �����i�r�J �t 7��' s�;� ���f������� �� ,�„' � � , , � `�# � <br /> 5�1 �y{y a�4 Ir^�� � r: s K,�fi. K �.�"�5 � i'i t5�b k <br /> � � � i f i � � � �i <br /> x�Si'�ff.��.��j.�'til'�S�i e�,��r�I a�e i��i_'�� t �1u � �.L�i�.� �.7�.t�.���i� 1�'- �� .,:e'„� V�a�'',� �{ �xi��3 ��� <br /> �:§: r:r1n.-.`t�' i. ..�a {A..�,.v4 ,��`���F r -��'-.��. .f` =.k�"4�1 �.,r+�. <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> I. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�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 $ ]5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ Z.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />