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12/12 2012 03:00 FAX T634773629 f�0021003 <br /> � <br />. .. q.� .f:lil'.•'�' �� ..' l�4' 14^.if�ii•.uu "it� N� �:ti . . <br /> ;w:..v:►�i.��•h�{'':�.t..YII��4�. �� 0 q <br /> 11N � ���� <br /> i <br /> •��. ���' �.� i iwi <br /> � ... � ...�� ' <br /> :•K'lx�X"•:fl�!::li��'�";'tl.:§.�• <br /> t�IXTURE BSM7' l 2 O'1'9iER 1�IXTUR� BSMT 1 2 OT! L�Ci <br /> TYPr•. �I. r�. TI�E CI. FL <br /> W acer Closet Floar Drains <br /> Lavatory 3 Sewcr Ejeccor <br /> Ba[hn�b � Laundry Tmy <br /> Silowcr ( Washer ( <br /> Kitchcn Sink ( WaterHeeter <br /> ,� :.^ �� � ^ Dispoxal -• - --. ��, � Water Softener . <br /> Dishwashcr ( W et Bar <br /> Sillcocks Miscellaneous <br /> � _ <br /> , . � H�, � ,> ::� ' � <br /> ;'ih�k�:`;''"',�4�"�� it .: � � a';"w, .,{;.�� <br /> ;�it:�.,;N�C�.� r �' (' ' ';� r�• i�i.�;�' ,���� <br /> ;,s,j`!"•;,1!b��;��es��/ � j� �i nG�m+, 'l.;r <br /> rc•� <br /> ❑ Yes,this section applies <br /> 'I'hc replacement of only one Rssi tial F rc or liance that meeLs all tiv'ee of thz fpilowit►S <br /> rtquirements: <br /> 1, l�ocs not require madification to cl�ctrical or gag service. <br /> 2, Ha�a al cos �f SSOO.UO or lcss:excludin�thc wst of the f�xturc or apPliance=an� <br /> 3. Is irnprovcd, installed or replaeed by the homcawner or licensed plumbing contraekir. <br /> Skip ncxt section,if this applies; Cost of Permil S 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-ln Fec(lf Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Pcrmit Fecs Continued On Next Pa�e) <br /> 2 <br />