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10/11/2010 12:47 FAX 9529335049 CULLIGAN MNTKA [�003 <br /> �`i- ,�"� —:T�>��$�C"i�I�'1'�.�RE�S`,��,�'.x:��.�'�'1�►�.i�.�'� ;;s ''�.;;�� ��' <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 /> � 5 a�� a ,��ti I '�`r x �„ + �'�"fv'�'� �'�� "�".�''�,t'`'� Y��#'4 k <br /> '� i �"� t r�`v'� ti'� j"��i`��''��'�����"��,�.,��.�.1���� � E 4, ��� F�x�� a�'� �sa�L`� <br /> }�uw-:�r � ti� ���r�i+3�i� ��dV t r � � ':�,,,� 4�� �"� �t� �a �K��t�,r�:.y'�1'�i"l�"�'� ? r�� <br /> „�tbyt�il� �� ,t Y: rN4{'r v.�t ,��d �.a�t i .H Y-�'t i-� t��.�?���7��..�¢c�ra.,' <br /> ,� =z,��,� �,rr�� �W,x. �� A�F�] OFE-- 2002 STAT��. '���1''7'�� �,,,���_ �; <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not reguire modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or Iess;excludiae the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> 5kip next section,if this applies; Cost of Permit $ I 5.00 <br /> Stata Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />