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O1/24/2017 TUE z1: 36 FAX Ark Mdndg�mpnt �003/00� <br /> �, riiv�zs����a�x��'t:r�:�s� rrr '�sfi�,L��'�� � <br /> FIXTURL �SMT 1 2 OT��It FIXTURE BSMT 1 2 OTHER <br /> TYPfi FL FL TYPL FL I�C, <br /> Water CIoset Floor nraine <br /> Lavatory Sewer Ejeotor <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> DisposAl Water o ener <br /> Dishwasher Wel Bar <br /> � 5il lcocks Miseel laneoua <br /> , �`��I ��AL��1L'ATI(�I�t(S) <br /> �. BASED�FF'-. � 2�STA,�'E"�T,A.TT� ' , <br /> ❑ Yes,this section applies <br /> The roplacament of anly one Residential fixture or aqqlianoe that rneets all three of the followittg <br /> requirements: <br /> 1. Dc n require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludina the cost of the fixture or applianee:ond <br /> 3. Is improvcd,instalfcd or rcplaced by the homeowner or liCensed plutllbing contCBCtor. <br /> Skip next section,if this applies; Cost oFPermit $ 15,00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 � <br /> Tatel Parmit Fee S <br /> (Perm�t Fcce Continucd On Nc�t Psac) <br /> 2 , <br />