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03/27/2012 11:59 FAX 9529335049 CULLIGAN MNTKA 1�003 <br /> F r'�L � �� :4„�y ' iA 1�j'��� �4J: �1.� �L'111���Z�L�)��$���'� ;:i;:.;�;;'•""�T' 'y�,�',',;i�t� V-�' <br /> }.� �dh,. <br /> ,[�.yh,. � :�L" ) r •L« .,�.i sN�..:,o. ,t.. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> T.YPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewar Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sil Icocks Misceilaneous <br /> ri} +� si ��''-ra � cw �kjx t � `r �a y{y'E'� ',�`'�.g�,fi�,+�� r�kPY�NI�y+.l�S�btr�.�'� <br /> rv,, a}P,�"!1-)p;2h't� l'`'{� ��a � 1 a �' { i t (�T�� �}�-� ttl i E�n"i 7iVi� ru,� .�.• <br /> j � . <br /> � �1� ti � � �s 3 ,5 x� �y� . � � . ��r����y.Tr4��,��, �.�,� ,t�r5�.��,, rar w��i��''4 r ` <br /> i i.,�.C r ,t`�t � f . !s :I "# i ,�,..5..i; xF. Z`�,, ti ''� � �. �!'tir�r 'r <br /> S41,ry���a�r, j t [ � �r )k 7 n M1�7�i'it( sr. 3 D Y t + <br /> � y }. S � < T <br /> :, �.�r.r���.���:�; �"r,��,�r ;,�4��� ���1�; ��02�ST�`I�'�;I'A?�� ,.,'��., �.t�-���.��;_��:.,� ,�n <br /> Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three ofthe following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;axcludina the cost of the fixture or appliance:and <br /> 3_ ls improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Tota!Permit Fee $ <br /> (Permit Fees Continued On Next Page) - <br /> 2 <br />