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03/06/2013 13:1 FA�X 9529335049 CULLIGAN MNTKA C�003 <br /> � <br /> i <br /> � � <br /> i i <br /> . ,,.�..�v u,�,.,��:'�r���i.. .�. :�1� ..F��:tf.�.�Y.•��� <br /> . � '.'t... .. <br /> y .) ti�-� ...':':.�c �+ y �;y �c <br /> :�:U�..'.'.�'v.�.��.. .,.: .il:'.' L:.�'!' /� i.! :1... - <br /> � .5 � .•��t . . i�'.'� � .•' i�:.��'�i..; .. <br /> � . . . � . ... • �:..�,�,1•' ..... ..�.::. <br /> .n r;:..i' I.,:i:ti:�;i <br /> �'f'<.: ;i;.�'' - :f_ ',,.`���•°'���`\t7=.���7� L"+�.. .-1:+i �'T"i��:' <br /> - ,�,:.:.,.;;>: <br /> r,,. , <br /> � ..;.� <br /> �...e:-r.�.�if�� . . � ... <br /> ur:�;...r;:� �' <br /> ,.. .i.�....;.�.� ; <br /> •r.„� .�.:<`:�:...,..;...�i..... .. .. .. . . . ... . .,.,:.., .. . . <br /> FI TURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> T PE FL FL TYPE FL FL <br /> I <br /> W ter oset Floor Drains <br /> L atory 5ewer Ejector <br /> B thtub Laundry Tray <br /> S ower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> 1 <br /> � Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ih u �f e i , t� R �7-t ji 2"r�'.p ��t �y.q+.�„f'� � ". ,.r:,'i <br /> ' ��.ti� ��,�,�Hi������r�"� '�y �, et��4�klJ �l�fiz ' i� �`f7+hy 4 �� i �``�i� <br /> I� ��x'hi��l4it'+�p ytn}�N���x��' y�t, �;a ! r ' �'k' � .� `ty'3��1�'��t ��d4 �6t ,y��ir a <br /> ,:��-�``�{�?�7x'fi�''x,��,�,]�v�+�.�,��� ro � d ��,Fr� �w �y F�. <br /> ,::�F�� -��. ....I' ��t� r�t s- , ��� r�'«. � .:-�� <br /> ❑ Yes,this section applies <br /> e replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> p Does�ot require 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 � l 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ermit ees Continued On Next Page) <br /> i� 2 <br />