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12/14/2015 14:05 FAX 9529335049 CULLIGAN MNTKA [1003 <br /> �-+' .,rn 1 i�.)i!S Ilrlty..:'r' ,1;12�1vV'7!11!.711, �� P 17MDP1��?' �1•L'l11�� I'6+ i`°'q.r"'•" ,r''•,i'V; <br /> FIXTURE BSMT 15T 2ND OTHER FIXTURE BSMT 1ST 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 Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> -:•.;L�.I��. '�'�RR�'i%T%i�'���t%."3" '�'f'itl'r, r �,,, iuI ^s�riihl.;,�.,,,�rr r RC: � ^,,.+1+ <br /> 'Iy'il;c!i S17R+nry1•�Ayil,IfgVIVr^,li''a l,. �9,rr„�,I;l iro•IIi •Ih;r 1,T ,I,•,,,, r.al� .q,,�s,�r�r:'• L.,�" `.1 k.H'i,'1='FI�h;,l:"ri'�"ll�!n;;•f' <br /> '%4.a n,,:,ry;,l.t."J,Y '; ",;l'•, ,.•.;$.� ED�;O ' '„ .Ll l),2'STA.T, $.TtJTi!. 1'w �:., ,;;y; q,° :. <br /> 0 Yes,this section applies <br /> The replacement of a Residennt'al 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 l�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,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />