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12/11/2014 13:59 FAX 9529335049 CULLIGAN MNTKA 0003 <br /> , . <br /> '1.7i?.ti:I.MliAlfi,,(,ii"fAV.gki',5,0.r .'41l:140. ; SISSN011irglAtILKO::ff?'''.g440;1`C',- ;;7,4r; <br /> FIXTURE BSMT 1 2ND OTHER FIXTURE BSMT 2N° 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 Heater <br /> Disposal Water Softener <br /> , • <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 3104r <br /> EE1-1PA. *lia•AM•VV03." • •, <br /> 0 Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of 5500.00 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,if this applies; Cost of Permit $ 15.0Q <br /> State Surcharge $ <br /> Mail-In Pee(If Applicable) S /00 <br /> Total Permit Fee <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />