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04/12/2012 15:15 FAX 9529335049 CULLIGAN MNTKA C�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 Scwer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower W asher
<br /> iKitchen Sink Water Heater
<br /> Disposal Water 5oftener
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> � Yes,this section applies
<br /> The replacement of a gesidential fixture or appliance that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a total cost of$500.00 or less;exc in the eost of the fixturo or appliance:and
<br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor,
<br /> I Skip next section,if this applies; Cost of Permit $ 15.00 �
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> (Permit Fees Continued On Next Page) � ,
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