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03/28/2011 13:10 FAX 9529335049 CULLIGAN MNTKA (�003
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<br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 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 Softener I
<br /> Dishwasher Wet Bar
<br /> Silicocks Miscellaneous
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<br /> Yes,this se�tion applie�
<br /> The replacement of a Residential fixture or appliance that meets all three of the following roquirements:
<br /> ]. Does not require modification to electrical or gas service,
<br /> 2. H�s a total cost of$500.00 or less;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 Surcharge $ 5.00
<br /> I Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee S
<br /> � (Per it Fees Continued On Next Page)
<br /> 2
<br /> y
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