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08/26/2013 12:06 FAX 9529335049 CULLIGAN MNTKA �003 <br /> � � <br /> `PLU�!IB1NG FIX1'U„RES BE�]NCY��TA�lEIa . : <br /> FIXTURE BSMT 1 2 ° OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL PL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory 5ewer Ejector <br /> Bathtub Laundry'I'ray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> � <br /> Dishwasher Wet Bar <br /> Siilcocks Miscellaneous <br /> �,,��� ' r� '< < �`�� '` ,� ''� � �'1'��%I�T����F,E�CALCL��A'TZON(S} �s�,: ' ' `� ,� x a ,���-�-r.., <br /> �u'� ";,`'� �r�:,;'� ''., BASEll 4,F�' -2002 STATE 5'7'ATC:� <br /> ��z;� ,���.���_<_ ��,34 ` ,r �+�' <br /> r ` � �� ;a r <br /> - _ >,.. ��,�: �:�;�'" <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or app(iance that meets all three of the following requirements: <br /> 1. oes not require modification to electrica!or gas service. <br /> 2. Has a total cost of$500.04 or 1ess;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 $ 15.00 <br /> State 5urcharge $ 5.00 <br /> Mait-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />