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10%27/2015 14:15 FAX. 9529335049 CULLIGAN MNM 0 003 <br /> A <br /> '.4y;�k� fr.•i,;r'npu.iNl.rl',,;u°.tr .AFr—L-30 .6 'I SiTp� ,� L7,t�I�i ',T, c y�l� „�:���Ir+�,�{ �7'' <br /> FIXTURE BSMT I 2 OTHER FIXTURE BSMT In 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Hcater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> .4�1'.};,r,1,,� 'q°' 'I`,^;;.� t i�'ah- t S 1 tr" 1 , a t�:r r 'c;i•far 'i 7;41'�tr~�'�.• 'C;";�I; , <br /> 1,' " •4�. i. �Iir.d'L r.5 l i ' Lf 1 ''," 'L t t,rr' <br /> rtii° ,inl'r,Z,r i��,r:,`r '•n�:'i; l'„' �����i.J,,IJS'"LS�jO00Git7L °,i7^J.t11;•,V�:i:•�',�. ^l�nl�+,l,l..,,,°;:,ate,.',"..r S�� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fb=c or appliance that meets all three of the following requirements: <br /> 1. Does r require modification to electrical or gas service. <br /> 2. Has a t tam. 1 cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,ifthis applies; Cost of Permit $ 15-00 <br /> State Surcharge 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />