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02/10/2011 1 :28 FA% 9529335049 CULLIGAN MIVTRA f�003 <br /> . - ' <br /> � � <br /> �A�}�e����i�, �s ; i�ihq,' ,ge. }� y�.,;�����^.��! <br /> dt '" 7. r:h:PJ. ��P:{• <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL Fl. <br /> i <br /> Weter Closet Ffoor Drains <br /> ���ory Sewer Ejector <br /> � Bathtub Laundry Tray <br /> Shower washer <br /> ' I <br /> , Kitchen Si�ilc Water Heater <br /> Di�sal Water Softener <br /> Dis�washe Wet Bar <br /> SiUFocks Miscallan�us <br /> I <br /> I . <br /> � <br /> I � <br /> I 1 <br /> I I <br /> � j <br /> < < a :a <br /> Yes, is section applies <br /> The replacement of a Residenti�l fixture or�npliance that meets all three of the following requirements: <br /> l. Does not require modification to electtical or gas service. <br /> 2. Hag e tota of 5500.00 or less; xclu in the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip qext section,if this applies; Co�t of Permit $ l 5.00 � <br /> � Stato Surcharge $ 5.00 <br /> I Mail-In Fee(If Applicable) S 2.00 <br /> Tobl Permit Fee S <br /> � I <br /> I <br /> (Permit Fees Continned Oa N rt Page) <br /> 2 <br /> � <br />