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03/18/2016 FRI 18: 53 FAx 612 822 5a08 AI.' A M�ptpY Plumbimg �006/007 <br /> I . . <br /> ,i , > <br /> ,� <br /> I, <br /> i <br /> � <br /> � <br /> I <br /> � a � � u <br /> , <br /> FTX'�URE BSMT 1 2 QTHER FIJ('I'U�LE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Wa�cr Closet Floor brains <br /> Lavatory Sewer Ejector <br /> Sathtub Laundry Tray <br /> Shower Washer <br /> ` Kitchen Sink ater Heater <br /> � <br /> Dispos�a[ Watcr Softenor <br /> Dishwashcr W�t Bar <br /> Sillcocks Miscellanzous <br /> � <br /> � <br /> ; <br /> � � �� 5 �� . ��s <br /> ❑ Ycs,this section ap � <br /> The replacement of only one Residenh• xturc or a liance that�r►eecs all three of the following <br /> requirements; <br /> 1. �requir�modification to cicctn or gas r..erviCe. <br /> 2. �ias a�ot�l eoat of$500.00 or lcsac;cxcludin ie cost of the fixture or appliance:and <br /> 3. Is impruvcd,insrtallcd or replaced by dte homeo zr ur liccnscd plumbing contractor. <br /> Skip ncxt scction,if this applies; Cost of�ecmit S 15.Q0 <br /> State Surcharg� $ --sr.9��� <br /> $ �^ i <br /> Tol�tl Permit Fee $ ; <br /> I <br /> j <br /> l <br /> (Pcrmit Fccs Continuccl On Next Page) <br /> 2 ' <br /> � _... -, ... . I <br />