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12/19/2011 14:14 FAX 9529335049 CULLIGAN MNTKA f�003
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<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 �
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> � Yes,this section applies
<br /> The replacement of a Residential fixture or�lianca that meets all three of the following requirements:
<br /> l. Does not require modification to electrical or gas service. •
<br /> 2. Has a total.cost of$500.00 or less;exclu ' the cost of the fixture or appliance:and
<br /> 3. Is improved,installed or replaced by the homeovmer or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surchazge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee S
<br /> (Permit Fees Continued On Next Page)
<br /> 2
<br />
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