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O1/12/2010 09:50 FAX 9529335049 CULLIGAN MNTRA 1�003 <br /> . <br /> . � � � <br /> �IJvld(`b"'ltE�,' ��a�j'�tr�-�.y tlA'd'� ,q���'+Y}' '�' t�i,�j��+ a �{ ��VI',, �r": <br /> ..�R r!!�j;F„�{i�.���M'���'•d=��k't•!•.iy.s�a� �'�` .�'�,T,` A7:Y��i'J�� r. `�'��':�$'�''�t1`.'�^`.,'�'.�:��Sii2�R�K�7F;�:Z,'`��,i��S✓i��, <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 O'THER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> I.avatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> ' Sillcocks Miscellaneous <br /> � , <br /> �, � <br /> Yes,this section applies <br /> The replacement of a Itesidential fixture or appliaace that meets a!1 three of the followiag requirements: <br /> 1. Doe require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the wst of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeawner or licensed contractor. <br /> Skip next section,if tEvs applies; Cost of Pera�it $ 15.00 <br /> � ' State Surcharge $ .50 � <br /> Mail-In Fee(If Applicable) $ 1.50 � <br /> Total Permit Fee � <br /> (Petmit Fees Continued On Nezt Paae) � <br /> 2 <br />