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� 03/28/2012 12:39 FAX 9529335049 CULLIGAN MNTKA C�003 <br /> � � " <br /> Y <br /> y.,c rliC« ..L a ' id �.SU�:int'a:; ,� ,�,T �`]�i�'? 77'�-y �rt [�}}� 'y _,ni i�-;,,.,,":� �}�;Jl"':..���� <br /> :j�i�:'i:�:e%r�' r �r' h„ ��. l'tI"+r�'3�'-��',D'PJ !J�'J�l��� t :;Y': <br /> .fP�, � FI?, ,,., ��',;"�.'i;� ,,: . <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 /> iBathtub Laundry Tray <br /> ; <br /> � Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> , Dishwasher Wet Bar <br /> � Sillcocks Miscellaneous <br /> ��iq'qt'4 ° T� �a ��.,�,�t}F'r;h e' " +� � t �� . S r �,x'�t L's'F,',.��� 4�j�S�µ �}` � ��i . <br /> s'�Y,ki�a��flt�.�''�„7�.cy'$� 7 L�F��t����-lau ���°`,rl��'i �.�'� 5��r'�"z�t �� � �� P! ��� r ni, ,� ry*11 .ta�u�r� � lcf t� <br /> , 'i�o��1friNkt�4�tj»?k'���?"i�i`d i�'�T�a���4-�, , tk't7�J../ '�,�,�� ,�V�6;Vi1,�'f j N �}'q �. �.�N��-G-�fi�����`"�- ��t�-�t;U�µz���'. <br /> 1 -a.t ssi^x..�;�r+� ,�,k��r�d:,5 <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appiiancg that meets all three of the following requirements: <br /> 1. Does not require modification to elecfical or gas service. <br /> ' 2. Has a total cost of$500.00 or less;exclud�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-1n Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> • (Permit Fees Continued On 1�1ezt Page) • ' <br /> , 2 <br />