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12/22/2010 13:57 FAX 9529335049 CULLIGAN MNTKA C�003 <br /> .;�. ,::;... <br /> '.,"•g.,'ik�ytb�Pfy t.���.`::�,x.t�..r�'1�.� y�`�' � �' .^F., ..,r "r�r�?'.,. 'iG�n°:t`;�'+'°;'t�'1q'.;;.?{?;'7?l:1.-:�:n.i�..:._,,_;! <br /> :f>. � T �i�,: <br /> ,F�d1;..i i, +�x�':F.tit: �i �:;�; �,�: [ •:�;� y ,.h�r.. ,�{,.i �; 1�� <br /> _ � :..r.V. �';iiiiY�: �.'�K'_'• � ��F:'1 ,�1��• :f:. _�'.'r,'ln��.:;J`.e?^t^;MJ;";C-0-:".:':. <br /> .;�T'r'� :r,k'%%.'�'•: <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 SoBener I <br /> Dishwasher Wet Bar <br /> 5ilicocks Miscellaneous <br /> , <br /> lx(a, �r H+ y,t <br /> � a � 1 `�4� p� ���{�, ; E ���C��l'1 r r� �dk'Qtj z,�r'T1���AS t t �b � ti�r <br /> �f �a-�t�z �� 8,.� u�zr��Y�a� s � v.- {��� � � t����` d{+�� �, <br /> � , a ) �r�5 rr ti�1c� °i i <br /> '� t r k =-t"�. v .:� }.�x �-;� � � ',-w t�� r'�tit!'�i� �.��� �'�r�if���(1�'�' .� <br /> m�' � � + i z � /��y/� [� "y'} �4 �!�r;-SC� <br /> . �vlr�5e�:`�Rf� b��,��:tit'?'��sh�.kn�1� ti.� LVU�,1J���i�1•�,�; ,��a..xrc[it'��;���.�`�'�w. .i�-a��f; <br /> � Yes,this section applies <br /> The rcplacemeni of a Residential fixture or appliance that meets all three of the following requirernents: <br /> l. es not reguire modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine 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,ifthis applies; Cost of Permit $ 15.00 <br /> State Swchazge $ 5•OQ <br /> Mail-1n Fee(If Applicable) $_ 2.� <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />