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+ 03%20/2613 21:44 6519948701 JANECKYPLUMBING PAGE 62 <br /> FIJCT'[JRE �SMT 1- 2 OTFiE�t FIX'I LlRE BSM7' 1.' 2 OT'I�R <br /> TYPE FL FL TYPE FL FL <br /> Water Clcset FlOor TJrains <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower J washer <br /> ! <br /> Kitchen Sink R'��''H�� <br /> Disposal Water Softe�er <br /> Dishwasher w��� <br /> Sillcocks Miscelianoous <br /> � <br /> ❑ Ycs,t�is sedion applies <br /> The replaccment of only onc Residcn'al fixtur�_a2_a�vlimix that meets ail three of the�'atlowring <br /> requirem.enfis: ' <br /> 1. �n rr,qu�'re modification to electrical or gas servtce. <br /> 2. Hes a tota of$500.00 or less; in the oaRt of the fxtuce or applianc�:and <br /> 3, is improved,installcd or replacEd by the hoittcov�mer ot liCcnsed plwnbing contractor. <br /> Skip next sec�ion,if this applies; Cost af Penmit $15.00 <br /> S�te 5urchaor$e $5.00 <br /> Mail-In�ee(�f Applicable) �_ Z.OQ <br /> Total Permi�t�ee $ <br /> (Pern�it F'ces Continaed On Nezt Pag�) <br /> 2 <br />