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08/26/2013 15:41 9524960064 APPLIANCE CONNECTION PAGE 62/63
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<br /> FIXTCTR� �SMT � 2 OTI�R �'IXT(JR� BSMT 1 2 OTi-�R
<br /> TYPE 'F[., FL TYPB FX, �'X.
<br /> V17ater Closet �'loor Ih�ins
<br /> T,avarory Sewer Ejector
<br /> Bathtub Y.aundry 7ray
<br /> Shower Washer
<br /> XC,itchefq$xnlc VJater Heater .t
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<br /> �isposal Watcr Softcner
<br /> Aishwashe� Wet$at'
<br /> Sil�cocks Miscellaneous
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<br /> (� Yes,this section applies
<br /> '�Ete replactmcnt of only one Residential fixture or a�piiance that meets all three of the foilowing
<br /> �equi�e�e7pts:
<br /> 1. Does not require modi�ication co etecuicaS or gas sexvice.
<br /> 2. Has a total cosc of�5Q0.00 or less; cie„�c u_ding the cost of tb,e fii�ure or appliance:and
<br /> 3. Is impro�vec�installed or rc�laced by the hoznemvxier or licensed plumbing eontractox.
<br /> Skip nexc secriou,if this applies; Cost of Permat $ I5.00
<br /> State Surchaxge $ 5.00
<br /> Mail-In Fee(If Applicab�e) $ 2.00
<br /> Tota1 Permit Fee $�
<br /> (pettnit�'ees ConNnued On Next Pa�e)
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