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08l14/2012 21 :35 FAX �s3a���s2s �oosroo� <br /> . <br /> , ' _. I <br /> I <br /> i <br /> ��"qfii j,�!" f��f. <br /> 1'TX RJ�.! f3SMT 1 2 U'fHER FIX7'(JRE BSMT � � 7'FIER <br /> TYPG FL FL TYPE <br /> Wal�r Closcl � Rloor Drains <br /> Lava Sewcr L•j ectur � <br /> � <br /> �a�i b Laundry Tray <br /> �.� <br /> snow r � w��'� � <br /> Kitch n Sink � WA��Y� <br />,;. . . , ..., : . _ . . . _ �1Natti So�ftcner <br />� � � � � D'ts al � � .. � <br /> L7ish aRher / WetBt�r <br /> / <br /> Sill• ks Miscellanec�us <br /> I <br /> Nip. � �� I <br /> n�i���'ya�� <br /> i � <br /> ;,.,.4.., r�',��' , � <br /> � Yes,this�ection applies <br /> The lacem�nt af on�y one�sid ntial fixture��p���mee�s xU throa af thC following <br /> requ�ments: <br /> 1, pugg.�require modificafion to elecfical or gas service. <br /> Z, Has a tolal cost of$500.00 ot less;exc i the cost of tho fixtuce o*ePpliance: <br /> 3. is improved,installed or replaced by the hom�wner or licensed plumbing con <br /> Cost of Yermit � • � <br /> Skip next section.if this a}�pties; $ Q <br /> Statc Surchatge <br /> Mail-ln Fcc(If Applicable) $ <br /> Total Permit Fce s <br /> � <br /> (Pe�rm�t Fec <br /> s Contiaued On Nezt Page) .I <br /> '� <br /> 2 �I <br /> I <br /> � <br />