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06/19/2012 23:02 AX 7634775629 I f�002/003 <br /> � � �k <br /> . <br /> . � <br /> t <br /> . -,� <br /> � <br /> i <br /> •; <br /> .; <br /> , <br /> • .. , . . . . :� . <br /> .. ... .. . . ..... ., <br /> � . .. � . ..�f�H1.n)M�•. <br /> ���1.: '�Y'1:���:�i :��11� � 11L . .. ` <br /> •,•¢�� � <br /> F XTURE BSMT I 2 OT�-1ER F[X1UR� B3MT t � <br /> ��� PE FL F7, 1VpE FL � OTHER � <br /> , <br /> atcr Clo3et Floor Drains � <br /> L vatory Scnver Ejector � <br /> � B tl�tub � <br /> �t Laundry'Ray � <br /> , <br /> S ower , Wesher � <br /> ! <br /> Ki he�Sink ' �y�y�. �� <br /> � <br /> Di posal Water Softenw �� <br /> � _ .� <br /> Di hwashCr ' Wet Bar I � <br /> Sil cocks � <br /> Misccllaneous :� <br /> � <br /> f <br /> � <br /> ' e <br /> .i <br /> .1 <br /> � <br /> � <br /> k <br /> �. � ..I.�....n..�.i 4.n;1 i.i I �',� 1� � <br /> G 1MIhIM <br /> ' :�.•:,��.. .A':";�.:•:r(wl�y�.��„ 'u ''�IN e�r:.;,.,..�: ,t:,,: <br /> .. .• ..:;�:p .,�W.:.„ a ,,'�tr'.� • : . . .. • . <br /> �:��q;.4'.y � ,�,f=�r�.y;�. :::;.•: <br /> . � +•M`�vnYl ,Vtid��'�IV �0+� �';y�:����1 � .N.i 1 <br /> �':.'�I�•M:L��•wJ s*co;v�:H�. <br /> Rk I"r <br /> ❑ Yes,this sectian applies <br /> 'fh replRcement of only one$��gntial fixture or spplianee that mects all three of the foliow g � <br /> i�eq iremenu; I .� <br /> � <br /> 1. Does n require modification to oleecrieai or gas se�vica. ;� <br /> 2. Has a total cost of 5500.00 or Iess; �di tho cost of the fixture or appliance: i <br /> 3. Is improvsd,installed or replaced by the homeowner or licensod plumbing wn r. .� <br /> Skip next seclion,if this applics; Cost of Pennit $ � <br /> State Surchargo $ 00 .� <br /> Mail-In Fcc(if Applicablv) $ ,0 <br /> Total Permit Fcc $ ; <br /> � <br /> � <br /> :f <br /> f <br /> � <br /> ;e <br /> i <br /> (Pe�m1t N'ces Conttnucci On Next Pap,e) �� <br /> ,� <br /> � <br /> � <br /> , 2 � <br /> � <br /> t <br /> � <br /> R <br />