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12l12/2012 03: 11 FAH 7634773629 1�0031004
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<br /> fIXTUR BSM1- � 2 071�R FIX"�1nE BSMT I 2 c�Ti r•.R
<br /> TYPt ', FL FL TYP); FL FL
<br /> IWatcrCl set � � floorDrains
<br /> I.avacc�iy ' Sewc3r Ejector
<br /> Bachcub r Laundry Tray
<br /> Showr� ( Washcr I
<br /> Kitchen$fnk � WeterHeater
<br /> Disposal I Watcr Softener
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<br /> Dishwasher Wel Bar -
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<br /> Sil{cocks ' Misccllaneous
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<br /> ' ❑ Yes.this.sec[ioa applies,. ". �
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<br /> � The repla¢emarrE of only one Residential fixture or�p1' eoe tl'►at meets all three of the.fol�owing.,._ _ .._. _.
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<br /> ` ^2: I��las a.tota cos of 5500.00 or.less;l�clex Iud�nQ hecast ofthe fixture or appliance:an
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<br /> `'' 3. ls;improved,installed r laced thehomeowncror licensed lumbm contr�ctor.
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<br /> ,"` Skip next section, if this appiies; Cost�of Pennit $ 15.00
<br /> _ _,__ ,_.. . . __ : • _.., State.�uroharge . _ _. ._��_
<br /> �., ,Mai1-Tn Fee(rf Applicable) , $�
<br /> I � __ _ .._Total Permit Fee �
<br /> (Peri»it�ees Continued On Next Page)
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