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04/07/2014 14:15 FAX 9529335049 CULLIGAN MNTKA �003
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<br /> FIXTURE BSMT l 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> TYPE FL FL TYPE FL FL
<br /> Water Closet Floor Drains
<br /> Lavatory 5ewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener I
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<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> ':4. �{i�' Y;a'A'r{�(�.'-'����t''XI.
<br /> Yes,this saction applies
<br /> Tha replacement of a Residential frxture or aRpliance that meeis all three of the following requirements:
<br /> 1. Dces not require modification to olectrical or gas service,
<br /> 2. Has a total cost of$500.00 or less; clu i the wst of the fixture or sppliance: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 Surchsrge $_ 5.00
<br /> Mail-In Fee(If Applicable) � 2.00
<br /> Total Permit Fee $
<br /> (Permit Fees Continued On Next Page)
<br /> 2
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