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, <br /> . <br /> F�Tf3ltE BSMI' 1 2 OrfFiER FlXTfJRE BSMT 1 2 O� <br /> TYPfi FL kL � TYP� FL Fi. <br /> Wate�Closet � F1oar D�a�s <br /> Lavatiory � 5ew�r Bjecbr <br /> Bettnoa� �Y T�Y � <br /> Show�er Wsstier � <br /> Kitcl'ren Smk / WaterHc��er / <br /> D,isposal we#er sot� <br /> n;�h°"� ��.rr / <br /> s;�lkocks MisceUaueous �} <br /> J�f f <br /> Sa u"� <br /> ❑ Yes,$�is�riam spplies <br /> 17�teplscement of a _ _ f�xhn+e ot sopliaaoa tivat meets all tbnee of the foIIowiag x+eq�ents: <br /> 1. Does�ut ieqtrize modi�c�on to elxlrical or gas s�e�vice. <br /> 2. �es a�mi��af$500.00 az l,ess;�g t�oost of the 6uctv�e or appliao�ce:and <br /> 3. Is improve�msmllad.or replaced by the ho�e�owner or lice�osed coacliactaz_ <br /> Sldp n,e��eclion,if this applies Ca�ofi Permit S ]5.00 <br /> State 5iar.harge $ .50 <br /> M�1 zn r•ee(!f apphcabl�� �_�4 <br /> ToW Permit Bee S <br /> (Permit Feee Coqqnued On Nut Page) <br /> 2 <br /> Z00 QJ �HI'ZZIY2IOH 9��i� �Z6 C9L XV3 b���T LOOZ/Zi/TO <br />