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12/13/2011 13:55 FAX 9519335049 CULLIGAN MNTKA C�003 <br /> . � <br /> _ •a'• �t :;J;�'1;',�i'i('.^:i�;', <br /> ��N�'',��":i::.i"i��i '+1��'.i.i .. .c*�.r�;y�<'��qq y�y y. �.'Yri� � r `''uu`: <br /> �� -:.x•. __;'�F'•�E;j'.�:;,;N:S�f�;��',�k}r' %��.;Lk�l�7..i`;. .. B�}��..`k�ri�����,�� e ,.�. �wr;'.., <br /> FIXTURE BSMT 1 2 OTHER FIXTURE HSMT I 2 OTHER <br /> T,YPE FL FL TYPE FL FL . <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �', i E 2+i ,a �x''. �� �} �P`{,�,,,,�{� r, � '��„ n ri6iih � �I�y�',�° P �x <br /> , �ij���,'a�E ����"'�'a���ir rh� �wtx��"��g''��� �j E,, ,.t�.� � "' ` � � r i � i 4•, '��J e'ky g��ry�„���r r, <br /> l '�fi�y"" � �ft ,���{ �.� 1 �"�2�''jl 'u, i�� i-'r�1 { at.�' 7'�t.�,� G,-c'�',('��k l7'�'��p��-t�� <br /> i i i F��y���jEry�r„��a x i:+�i s ��i�`t�"� �• � � ,l..x( �t y-� ��„+, i �- '9 .����.,. � . <br /> �,:,,�_ , ��..� .4?-� �., � ,��;�ASE�7 O�'i� ..'�,f`�.Q�`°��� .� ''�.:�...r- � G���.>����:���� ���:,. <br /> Yes,this section applies <br /> The replacement of a�Zesidential fixture or aapliance that meets all three of the following requirements; <br /> ]. Does not require modification to etectrical 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,installed or replaced by the horneowner 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 /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) . <br /> 2 <br />