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05/07/�015 THU 18: 03 Ftax �002/003 <br /> , � <br /> . � <br /> FIX1'UR� DSMT I 2 OTI1�R C7X�'CT�tE B3MT 1 2 OTHER <br /> TYPL� FL FL TYPB FL FL � <br /> � Watar Closet Floor Drains <br /> Lavnlory Saw�Ejector <br /> Aathtub Laund�y'flay <br /> Shov�rer Waeher � <br /> Kitchen Sink �y��l•��� 1 <br /> D�SPo�1 Water Softener <br /> Dishw�sher µr�g� <br /> 5��� MISC�llBrlepu3 <br /> I <br /> I <br /> . I <br /> � 0 Yes,this seotion applies <br /> The ceplacement o�'only one Re�id�tial fixture or s��i n e that meets al�Nuee of�e foUowlne <br /> raquirements: � <br /> 1. not i�aquire modificakion to eloctrical or gss sarvioe. <br /> 2. Has a c et of$500,00 or lese; c i the oost of t�e�ixture or applisnce:end . <br /> 3. [s improved,�ittistallad or replaced by the homeowner or Ncensed plumbing cvntr�tor. <br /> Slcip next section,if this applies; COst o£Pe[xnit S_.__15•00 <br /> State Sutcd�arge $�,_,�,,QQ <br /> Ma�l-In Fea(If Applicablo) $ , 2.00 <br /> Total�ermit Fes S <br /> (Pormli Feex Canlinned Od NeYt Page) <br /> 2 <br />