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06/19/2012 23:0� FAX 7634775629 f�002/004 <br /> � I <br /> F!'XTURE BSMT 1 2 O'[T�R fi[XTURE �SMT 1 2 O�R <br /> �� FL A(, Typg � <br /> FL FI, <br /> W ter Closet Floor prains � <br /> Lavatory Sewer Ejector <br /> Baihtub • <br /> � ��Y T�Y ' <br /> Shpw�r Washcr � <br /> K�b�S�� Waur Heater <br /> Di�,posal _ ' Water Softener , � <br /> Dis�washer Wet Bar <br /> S'���� Miscellaneaus <br /> Y �'� <br /> � � t <br /> ii� <br /> ❑ I Yes,this sw-tion applies <br /> The replstccmerit pf only one$�idcntial tixn,rc or appli.�th�mcets all three of the following <br /> r�qu�rements: . <br /> 1. es ot require modification oo clectricaJ or gas service. . <br /> ; Z. Has a sQtal cost of$500.00 or less;excludine the cost of the fixturc or appliance:and � <br /> 3. Is improved,installed or teplaced by 11te homeov►mer or licensed plumbing controctor , <br /> SWp next section,if thfc epplios; Cost of Permit S l5 <br /> ' State Surchazgo $ 5 � <br /> Mail-In Fa(1fAppGcable) $ 2 <br /> Total Permit Fee $ � <br /> (Pen�it Fees Condnued On Next pA¢e) � <br /> I 2 <br />