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06/O1/2011 13:18 FAX 9529335049 CULLIGAN MNTKA 1�003 <br /> >-, . �. . •,-:,.. ':;��u�,� . , . ,.. . =. <br /> G:�T�'I`iJ��$�TNG:iN�TA��;ED.: . -: '.; : �:� . � <br /> FIXTURE BSMT l 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer 8jector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen 5ink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sil{cocks Miscellaneous <br /> 7���i";:�n���1,t��. � �,(sY- ..S , 7r��;.�.'n Y��5 ��,�]7 � 1. �F�" _�tY �f �i��i�:i�'3�'.U�.ii?=r, �Y,,i��, "-�;".�y�i%"`�,y�`itiii'�4,`� n <br /> u ( i �`�d��.4 i i��ariK } ' 4e�S�� ����s�!].1.9 � ��.4d'1�� is � f x� ��r ° ft1 S <br /> r �Y�,;� t ictr' t�s � > � �r� :)l1 � �u4,.. -r +d�"�I r..!.y�1P���r y, �l� i� l�� ,�, � ir� t t'r <br /> �3 1,,,i i +�l , ,i� �o.rc�, � �47����� 2�0' { �-:t Pl J .�.. ,{- ] a�e-. <br /> '� � <br /> ..r..l.}_ixY'» !r.�.�' . j,. �-J ..,.P�.. .. . .. ' ,..,, �,. 4. . ...���l7 .' ��� -�( i,sl...., <br /> �� u <br /> Yes,this section applies <br /> The replacement of a Residential fixture or appfiance 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;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 ofPermit $ 15.00 <br /> State Surcharge $ 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 />