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09/05/2012 13:21 FA% 9529335049 CULLIGAN MNTRA f�003 <br /> , . , <br /> � �f,r,�_ a •y: ' f� ��„<'"'.•"•"Y�•.<+,� � .r.,, f�. <br /> ��k['�°'4.��•�fa 'i•N�.i :' t .0 '}"F.i-�� �;�::;:�;:�'!i <br /> i +.:;�,:Ti;i4�1.�S•r;�fc,•. ':���ii�'.IJ'- �'p• �.�'C� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTF�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Batfitub Laundry Tray <br /> Shower Washe�' <br /> Kitchen Sink Watex Heater <br /> .. ;. _ ,. . _ Disposal __ Water Softener _. <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � <br /> � Yes,this section applies <br /> The replacement of a Residentiaf fixhue or appliance that meets all thrce of the following requirements: <br /> 1. Does not require modification to elactrical or gas service. <br /> 2. Has a total cost of SS00.00 or less;excl ' the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensad contractor. <br /> Skip aext section,if this applies; Cost of Permit S 15.00 <br /> State Surcharge S S•00 <br /> Mail-In Fee(If Applicable) S 2.00 <br /> Total Permit Fee S <br /> (Permit Fe�s Conrinned On Next Page) <br /> 2 . <br />