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O1/18/2017 wao 19: 15 F�t 1�rk Ksnagement �J003/OOa <br /> , <br /> � <br /> ." ' �;PL�7.�I��� �`��1;�;� �'��� �;,,�. . ;�,��,; -,s.:. <br /> ' .t .:n <br /> FiXTURE BSMT 1 2 0'a'I-��R FIXTURE OSMT 1 Z OTHER <br /> � TYPE FL FL TYPE FL FL <br /> Water Ciosel Floor prains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Showa Washer <br /> �Citchen Sink Haater <br /> Di6posal a Saftener <br /> Dishwsshcr Wet Bar <br /> Sillcocks iscellanepu <br /> V�n� X i t`� �J'�V <br /> . . � �, � �"����r;g�:�.��Txo����.•; �� � .; . , <br /> ' �� � �� ' � �AS I���.�Y �.�Qq��.,�TATB.S�;4T�iE.,,� - , , , , <br /> ❑ Yes,this ion applies <br /> TMe replacement of only on idential fixturc or li nce that mests nee of the following <br /> requirements: <br /> 1. Does nat rcquire modificatio electrical or ervice� <br /> 2. Hae e total cost of SS00.00 or les�, cludi c ooat of the fixture qr appliance�and <br /> 3. Ys improved,inetalled or replaeed by t ome�owner or licex�sed plumbing contractor. <br /> Skip next section,if this appli � Cost o it � 15.00 <br /> State Surch S 5.00 <br /> Mail-In Feo(]f A 'c�ble) S 2.00 <br /> Totnl Permlt Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />