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� 03/07/�012 13:48 FA% 9529335049 CULLIGAN �ITRA C�003 <br /> i <br /> I _ - �. <br /> �' ... . . . ... ... . ... . � � - <br /> j • . . . . <br /> �, , •..• , .4�..�.�,:.:. ,,. ,�;_��s.�;,�-;. <br /> . .i .�;..,.ti'�•'�'y�;n;t..r, �i7il�n��� '� i k.i.`�.:��':��,-��4,{�fy�+'v:�+.rTR�..� <br /> 4 �� � <br /> .�.F .t.- :WM1i ' <br /> F,IXTURE •BSMT 1 2 � OTHER FIXTURE BSMT 1 2 OTHER � <br /> ii 'CYPE FL FL TYPE . FL FL . <br /> Water Closet Floor Draitis , <br /> ' Lavatory Sewer Ejector <br /> � Bathtub Laundry Tray <br /> ' Shower Washer <br /> � Kitchen S'uik Water Heater <br /> , � <br /> � <br /> _ . , ._ <br /> Disposal -. ^ .- . Water Softener ., , <br /> � Dishwasher W�B� <br /> I <br /> Sillcocks Miscellaneous <br /> . , , .r. ., <br /> ' � i � 5 z�G. � <br /> ' Yes,this section applies <br /> ' The replaccment of a�esidential fixture or,�ppliance that meets all three of the following requirements: <br /> ; 1. Does�o�require modifcation to electrical or ges service. <br /> ' . 2. Has a t cost of 5500.00 or less; xcl ' tha cost of the fixture or appliance:and • � � <br /> � 3. ts improved,installed or repl$ced by the homeowner or licensed contractor. <br /> , Skip next section,if this applies; Cost of Permit � 15.00 <br /> ' � Stato Surcharge $�UU ' ' <br /> . Mail-In Fee(If AppGcabie) $ Z.00 <br /> ' Total Pcrmit Fee S <br /> � (Permit Fees Continued On Nezt PAge) , � • . <br /> . • <br /> 2 <br />