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65/12/2614 10:17 7632592299 SCHULTIES PLUMBING PAGE 06/67 <br /> FIXTURE BSMT 1 2 OTHER FiXTI,JR� BSNIT 1' 2 OTt�R <br /> �!'XpE FL FL TYPF Fl, FL <br /> Water Clpset j Floorprains <br /> / <br /> Lavstory / �j Sewer Ejector <br /> Bathtub / Laundry Tray / <br /> 1 <br /> 5hower � f Wssher <br /> i / <br /> Ititohen si�k 1 water Heacer <br /> Dis osal / <br /> � f WAte1'Softener <br /> Dishwasher � W�g� l <br /> 5ilicocks � <br /> � Mi9Ccllaneous <br /> ❑ Yes,this section t�pplies <br /> The replaccment of on�ly oue Res,'LdentiRi fixture or an ]iance thaY mccts all three of the following <br /> requircments: <br /> 1. Daes n reyuirc mqdiftcatibn to electrical or gas service. <br /> 2. Has a total,cost of$SOO.OU or lcss; c di the cost of the fixture or apptian�e:and <br /> 3. Ts iimprovad,installcd or replaqed by the homeowner or lioettscd plumbiqg cpt�ttaxctar. <br /> Skip ncxt section,if this applies; Cost of Permit ' $ ]5.00 <br /> State Surcharge $_5.00 <br /> MAiI-In Fee(IfApplicabi.e) $ 2.00 <br /> Total Permit F'ce $ <br /> (Permit Fees Continaed 0o Ncxt Page) <br /> 2 <br />