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06/19l2012 22:58 FAx 7634775629 (�0021003 <br /> . . i <br /> •i <br /> i <br /> � <br /> . „ ;Y.; ,. . ,,,,, i <br /> -�..� �':'e;� �:;.;':, . . '• <br /> ...•,,•• 'r :�:., ��:,,;,' . .� <br /> FIX'fURE 6SMT 1 2 OTHER F1X'(URE BSMT t OTHER � <br /> TYPE Ff, FL � 1`YpE FG L <br /> � <br /> Water Closot Floor Drairis �� <br /> Lavatory � S�ra�j��. i <br /> I3athmb Laundr�,'tlay `' <br /> .� <br /> Showtr � �y�� ; <br /> ., <br /> Kitchen Sink ( �y�}t�� <br />� Dis sal ' <br /> F� � Watar Softener : <br /> _ . _ : <br /> _ - -. . .. _ , <br /> Dishw�aher t W�d� ! <br /> i <br /> SiUcocks MisceUeneous �; <br /> i <br /> � <br />� �i <br />, � <br /> .; <br />_ <br /> � <br /> � <br /> .:tll^w�.�A��"�Yii��Y��� � k. �.�1. '�'�i"1��. � ,1 <br /> . ,�,,.�;�,. ' T , . . <br /> '`*p ^N',y;�.'�,,';;•:c�e' y� v '"�w' „�!i�•�;:' ': . . � <br /> ;���.�i� .��f 1.?sn aLMY•,:'•;','1.:,}•. <br /> '•i�M: �n, j <br /> I . <br /> ❑ Ycs.this section applies 'r <br /> ,, <br /> . <br />: The rCplacemcnt of only one�sidential fixture or ap l�cg that meets all three of the f Ilo ng ` <br /> r�quiremants: •� <br /> h <br /> I. es not require modification to electrical orgas service. �� <br /> 2. l�as a t 1 c of 5500.00 0�less;E2cCludina the cost of tho fixture or appli nce and :; <br /> 3. Is improved,installed or replaced by the homeowner or licenstd plumbing on ctor. •� <br /> I <br /> Skip next scction,if this applies; Cost of Permit $ l �� <br /> 5tate Surcbarge $ � <br /> Mail-ln Fee(IfAppliaable) $ '� <br /> Totnl Permit Fee $ :; <br /> ., <br /> � <br /> .� <br /> 3 <br /> : <br /> ; <br /> �i <br /> .� <br /> ; <br /> (Permit Fees Continued On Next Page) � <br /> i <br /> , <br /> � <br /> i <br /> Z ' <br /> �i <br /> i <br />