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O1/0�/2013 13:50 FAX 9529335049 CULLIGAN MNTKA I�003
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<br /> FI�CTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> T E FL FL TYPB FI. FL
<br /> Water Closet Floor Drains
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<br /> L�vatory Sewer Ejector
<br /> B�thtub i Laundry Tray
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<br /> S�ower Washer
<br /> K�chen Sink Water Heater
<br /> ,� ,,,. D�,cposal _ _ _ _ Water Softener r ,,
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<br /> D�Shwasher Wet Bar
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<br /> Si�lcocks Miscellaneous
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<br /> � Yes,this section applies
<br /> T�replacement of a Res_i�ial fixture or appliance that meets all thrce of the following requirements:
<br /> I. Does not requ'v�modification to electrical or gas service.
<br /> 2. Has a total cost of$500,00 or less;axcludin�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 5urchazge $ 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 /> I
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