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09/20/2010 12:47 FAX 9529335049 CULLIGAN MNTKA C�003 <br /> ._ ► <br /> ,.:.;,,.,:� �� � �� ��;�.���������rr��rr�T�.i�, � <br /> �. <br /> FiXTURE BSMT 1 2 OTHER F1XT�JRE 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 <br /> �� �`t`,�'Ca�`.� ��3���a`ei�i 4 r 1td+���k`3��'���`it1V����li� L� l.��l,��A��-(i'���e�_i�yt�Ce�"�.�#,�a i 'ry�y;3! �'trl�t.'��� c�� <br /> � v t �rt t C +5 i� r zC��.. <br /> et�� �r�"�`A�-f e�����tiiy mr+ �t � y, r5i-v.�4 �,, � ��d ,� }i r..�� <br /> ��,,,��,�s����;.�,�'� " " ?'�,� C,�����:t�SED.O��-2�b2,ST��''�STAfiL+, +;, �� r,� , r n�� _� � � <br /> k i x,� e E� I i.� .ai th .9. �C.r.r- <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l. Does not reqpire modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�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,if this applies; Cost of Permit $ I 5.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee � a��bU <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />