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11/06/2015 11:28 FAX 9529aa5049 CULLIGAN MNTKA C�009
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<br /> F13C"CURE BSMT 1 2 OTH�1� FIXTURE 13SMT 1 2 OTHER
<br /> TYPE FL FL TYPE FL FL
<br /> Water Closet Ploor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundr}�Tray
<br /> Shower Washer
<br /> Kitchan Sink Water I�eater
<br /> Disposai Water Softener t
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<br /> Dishwashcr Wet Bar
<br /> Sillcocks Misceilaneous
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<br /> � Yes,this scction spplies
<br /> The replacement of a Residential f xiure or an lp iance that mecCs all three of the following requirements:
<br /> 1. Does not reyuire moda�cation to electrical or gas service.
<br /> 2. Has a total co�t qf$500_00 or less;exc din the cost of tht fixture o[3ppllance:and
<br /> 3. 15 improved,instalIed or rcplAced by t}le homeovma or lieensed contractor.
<br /> $kip nea:t section,if this applies; Cost of Permit $ I5.00
<br /> State Surcharge � $ 5.00
<br /> Mail-In Fee(If Applitabie) $ 2.00
<br /> 1"ota!Permit Fee $
<br /> (Permit�ees Continued On Next Page)
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