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11/03/2011 03:24 6519948701 JANECKYPLUMBING PAGE 02 <br /> I <br /> !Ya%i.ii IkX i,6! 3k-a,VBG '``?70f �x}11,6n 4:1t 4'" ''r .; .I Ali P {`n ra ;%s r r i i•!W,.`ia i.. :'./.; 1,4i i,: ,t,t,.l�i�sr 00 �S 4 <br /> ��lIN�,��IIJf„ .4x��' �,e(.'� l•.ra+,x.-yrt,,��,r„ �,,,�c.,:r..'h}�-4.� ,�.nllr�m�.w e.+ ,.:-rhn�k*1����:, �I�i��r��n"'!� �l�sf r. �rk�m�i ,u:,. <br /> FIXTURE BSMT 11. 2t1D OTHER FIXTLTRE BSMT lsr 2N1) OTHER <br /> TYPE FL. FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> rShower Washer <br /> J <br /> Kitchen Sink Water Heater + <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 0 Yes,this section applies <br /> The replacement of only one Residential fixture_or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of 5500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15_00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ ZOO <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />