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11/16/2010 15:31 FAX 9529335049 CULLIGAN MNTKA C�003 <br /> 7�y� �rj �° • .:r..' <br /> °F�•'�"t�r",;�r� :,�{•:�s��:�p:�,+° :'r"' '��,'��l1.Ry. ^� '+'�i��; ..�';i'�.. 'i�i�.�. `yr'Y���:�f''�47;::u�� <br /> FIX7'IJRE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory 5cwer Ejector <br /> Bathtub Laundry Tcay <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Ber <br /> Silicocks Miscellaneous <br /> tl .�, <br /> �� � � <br /> .,._ � ��� '� <br /> � Yes,this section applies <br /> .�� <br /> The replacement of a Residential fixture or a� I,q,i��that meets all threc of the foliowing roquirements: <br /> 1. D es require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;gxcludin¢the cost of the fixture or appliance:and <br /> 3. Is improved,instailed or replaced by the homeowner or licensed contractor. <br /> Skip next section;if this applies; Cost of Permit S 15.00 <br /> State Surcharge $ 5.00 <br /> Mail•ln Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Cootinued Oa Next Page) <br /> 2 <br />