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10/24/2011 13:28 FAX 9529335049 CULLIGAN MNTRA f�003 <br /> f . � <br /> �-.;� " •r,' .;��:^C��B;t1���E"�.'�ET�T�:�IS•T'�:T�;,.._ . . . � <br /> FIXTURE BSMT ] 2 OTHER FIXTURE SSMT 1 2 OTHER <br /> 7'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 /> . _. . <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Silicocks Miscellaneous <br /> yr' , A .�'.= 1 'e�� " ,M��p;f tp�(�y,.y�'. � L <br /> "{:i.w14�: NN�a��.3in , .1uC` � 'n�i t�'C'A�M'R'lG:�t�'"}..l:if�,, ��`}+�' <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to elecdrical or gas service. <br /> 2. Has a total cost of$500.00 or less; c in tha cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed wntractor. <br /> Skip ncxt section,if this applics; Cost of Permit S 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) S 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continned On Next Page) <br /> 2 <br />