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04/19/2016 10:33 FAX 9529335049 CULLIGAN MNTRA lj 015 <br /> 040000,43,1teginZtaNSTAIUO ,"). <br /> FIXTURE ' BSMT 15r 2N OTHER FIXTURE BSMT l 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lai/atory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocics Miscellaneous <br /> vilr.1",:gt:INdpi:;IqC41:4,94itag,g00442ittglig. <br /> 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$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 S 5.00 <br /> Mail-In Fee(If Applicable) $ .2.g0 <br /> Total Permit Fee <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />