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69/26/2011 02:15 6519948?01 JA�IECKYPLUMBING PAGE 92 <br /> FlXTURF HSMT 1 2 0'THER FDZT[TRE BSMT i 2 O�. <br /> 1'YPE FL F,[.. 'I'X�'E k"� PL <br /> Water Closet Floor Drains <br /> L,avatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kixhen 5ink Water�ea�er <br /> Disposal Rrater Sott�ner <br /> Dishwesher Wet Bar <br /> Silicocks Miscellaneous <br /> ❑ Xcs,�is soction applies <br /> The replacctnent af mly enc$�ia[fndl�re ar an��r,,�that meets all three ot'rhe following <br /> requireme�nts: <br /> 1. �require modi$cation to electracal or gaa service. <br /> 2. H,as a��o£5500.00 or leas;excl ieQ tl�e c�st of the fixaue or appliance:and <br /> 3. Is i�apmve�insta.11ed or rsplaced by the.homoownet oz liaensed plumbing contracEor. <br /> Skip next section,if this agplies; Cost of Permit S 15.00 <br /> State Surchetgv S__ 5.00 <br /> Mail-In�ee¢f Applicable) S 2.0� <br /> Total Permie Fee S <br /> (Per�mit Feee Continoed On Ne�tt Pa,�e) <br /> 2 <br />