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04/18/2013 18:44 FAX �634 75629 f�003/p08 <br /> . <br /> � <br /> g�'� � 1 2 OTFIER �'II�'[TRE BSMT 1 �� <br /> ,ryp+g gf, �L, Typ� FL, FL <br /> Water Cla�et � Flaor 17rains <br /> L�vatory . "� S�w�er Ejector <br /> J <br /> B�thtub Laun�ry Trsy <br /> shower r wsaher / <br /> gitch�n Sink r W�dru He�ei <br /> { <br /> ��l Weter SaRancr <br /> Disbwssher � Wet Bar <br /> Sillcocks Misoeilanev�s <br /> -,��.. `�s' " �� • � ', <br /> ;.�,�;�;�,r �- �. � ,:�. <br /> �.ti':i.jr <br /> .,�f�,4l+ ���� •Qf <br /> :t;: <br /> Q Yes.�s app� <br /> 'I�e roplaceuae�t of ly one i ' 1 fu ap�that mee�s alt three a�the following <br /> recauiremcmts: <br /> �_ �require�cation Uo slec�ic�l or gas�ervice. � <br /> 2. I�ias a of�500.00 or les�; lu � she ooat of the fnaure or appiiance:nnd <br /> 3. �,� ed,i�taIIed ot replacec�by the homeownac o�r liceosed Plumbing contractor. <br /> Skip sectiom,if th�applies; Ca�t of P�it �� <br /> State 3urr.hargo �—�-� � <br /> Mail-In Fce(if ApPGcable) $_2.� <br /> Tot�l Pe�rrmit Fce �.�.�- <br /> (Peroart�'e�Co� aed Oa Next Pa�) <br /> 2 <br />