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O1/21/2014 12:34 FAX 9529335049 CULLIGAN MNTKA C�003 <br /> . � • <br /> _ �`Px.,�J11�I$��ri"�I�,'I'C.]RES.'BE',3�IG T�tST�1LLrBD <br /> FIXTURE BSM1' I 2 OTHER FIXTL'RE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory 5ewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> llisposal Water Softener <br /> Dishwasher Wei Bar � <br /> Sillcocks Miscellaneous <br /> � �� ', ,�, ��. > " P�}�N1�T�� 7'+ �-1 �y <br /> ' ,�• � �..'L;I..A�.���A��iV'��� `� y r ' r <br /> �,��,; - � BASED�QFF. .2�0� S� E '' ' � � <br /> A"I.' �.�,�TUE.���` �' ,� , ��.,�:� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or�a pliance that meets a11 three of the following requirernents: <br /> 1. Does not require modification to electrica]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,instatled or replaced by the homeowner or licensed contractor, <br /> Skip ne�ct section,if this applies; Cost of Permit $ 15,00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ Z.pp <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />