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11/26/2013 22:04' FAX 7634775629 f�002/003 <br /> . • I <br /> �p�T�RE BSMT 1 2 OTHER FD�I'CTRE BSMT 1 O <br /> T'YPE FL FL TYP'E FL FL <br /> Waoer Closet Flarr Drains <br /> Lava ry Sawer�jecior <br /> Bathuib I.aundry Tray <br /> ( <br /> Shovt+�r Washer ! <br /> I <br /> Kitchpn Sink Watar��ter <br /> I <br /> Dispa�al � Water Soft�en� <br /> Dishwasher Wet Bar <br /> � <br /> Sillcacks M��� <br /> a�.. <br /> ❑ I YeB,tk�is sedion applios <br /> The reptacx�nent of ar�y ane R�sidential fixture or..���s��t meets all thrce af the following <br /> requ�rements: <br /> � 1. �require mudifiCatiot�to electrical or gas serviCe. <br /> 2, Has a tota4 co of SSOO.OU or less;e in the cost of the faxture or apptisnce:an�d <br /> i 3. is imprwed,installed or replaced by the homeowner or licensed pi�bin�cantractor. <br /> Skip na�ct sect�on.if this applics; Cost af Prrmit � 15. <br /> i Stata S urcharge � S. <br /> M�il-In Fee(if Applicable) $ 2 0 <br /> I �'otal Permit T+'ee � <br /> (Pei�mit Fees Coutinued On Nest Y�ge) <br /> � � <br />