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03/27/2�12 12:00 FAX 9529335049 CULLIGAN MNTKA C�006 <br /> . . . . . .. ..... ... . ........ <br /> � ..,���j,.'���i: i T /`ly�. ��yY,,, .�',uI`TI 1jjj " x <br /> . ,.,..� . , , <br /> ;y�'i$'i,Yt��:^^^t hi-::F 'i� S .'"r�� �•�lr ��.'..- { iJ`�����,i1F����� t ,1 ,t.� 1 .. <br /> ' <br /> !( . : ` l�}�^ <br /> ��r.c.... ,. . .'. <br /> ���.'.i . L'���x��•. n ��Y.';`� .-,�._ N ._.. .., '�. � M.... _., ��;.4 � ,�L.,S.I:v{j <br /> FIXTURE BSMT 1 2 OTHER FTXTURE BSMT I 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 Softenor I <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ' i y ; �:r,� d��tv`3�' �n.�j' y }� 'F `,�, T�� Sa�; w' i�-' . > w <br /> .n, !. I� `1 1 Y �„�£t i i��i,r �E��, � , 1L��'5��47 L ,�.'�,����!� k +,� Y 7fi;1.:y.,�i ., �t,��`�+`.tj '+V�-�`,�,' <br /> ��('i� ��fi�w-wu ��,.��ri,�,lF^�F��ye� ;+�}i- 'Tp �r1 rk � i a,�S ��acr , ry'��7�, �y r }-�x ;��Rr`£ 1f.��Y�qr���Yl��jay����� �Es.�1�tk. <br /> �#k�<I .iJ �,� �.�r ��x Ir'.�;/,:��� J_l���r-_� fiL �, i I����1 lr`k'�'�� t.`7: �� .,�'*��,1 I�+l+,rzCa�,�i�.ti=���t,i�rdy,�i <br /> .(,�`',� • <br /> [ F'4, r, n -�°• ;i �� ,7r���..._�i���.��'r r. ..a• '{ i F' <br /> Yes,this section applies <br /> The replacement of a Residential fiacture or a I�n iance that meets all three of the following requirements: <br /> 1. Does not require modification to elecErical or gas service. <br /> 2. Has a ota os 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,if this applics; Cost of Permit $ 15.�0 <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 />