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66/26/2011 22: 02 7637535125 NOWTHEN PLUMBING PAGE e3/04 <br /> PL�[JIVIBII�GFIX'TURE�'BE1N.G�T,�'�JS'7'AL'L�D ..'': . <br /> FIXTURE I�S.MT 1'� 2 OTl•fER F.fXTURE 135MT I' 2 OTHER <br /> TYPE FL FL <br /> TYPT; F.L FL <br /> Water Closet Floor DrainS <br /> Lavatory Sewer Ejector <br /> i3a.tlitub 1„aundiy Tray <br /> Shower Washer <br /> Kitchen Sink 2 Water 1-tcater <br /> Disposal ,� Water Soffener <br /> Uishw�shcr ,) Wct Ba� <br /> Sillcoeks Miscellaneous <br /> P��IT F£E <br /> CA��T;��JL�A�'IO';�;('�)�: ` <br /> ' ,BA�. .. ,: , , <br /> E� OF�' -2d�02 STt�T.E�:�T�Ti�: ' '`` `: <br /> ❑ Ycs,this section anplies <br /> Tlie replacement oFonly one eside Cial fi tUre a 1' nce thaC meeis all threc ofChe following <br /> requ i rements; <br /> 1. oes ot require modificAtion to clect�ical or gas service. <br /> Z. 1-fas a t al c t of 5500,00 or less;excl din tho cost of the�xture or appliance; and <br /> 3. Is improved,instal►ed or rcplaecd by the homeowner ar liecnsed plumbing contract:or, <br /> Skip nex1:section, if I:his arplics; Cost of Pennit $— �� <br /> StAtc Surcharge � 5� <br /> Mail-ln Fec(1f Applicable) $ Z.� <br /> Total Pcrmit Fee g <br /> (Permit Fcca Continued Qn I�fe:t PAge) <br /> 2 <br />