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't' 11/16/2913 08:60 9528947972 LAKESIDE PLUMBING PAGE 04/04
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<br /> FIXTURE 8SM7" 1 2 OTH�R RfXTURE BSMT 1• 2 ' OTfiER
<br /> TYPr FL FI� TYPr; FL FI.
<br /> WaMr Clbsct Floor Drains �
<br /> LAVAtory Scwct Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Wa,sher
<br /> Kitclien Sink � Water I lenter
<br /> I�IS�)OSflI Water Softener
<br /> DISIIWft9I1C� Wet Bar
<br /> Sillcocks Misccllancous
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<br /> ❑ Yes,this scction Rpplies
<br /> 1'he repincement of anly one Rasidential fixture or applia�tce that meets ali thre�of the following
<br /> requirementc:
<br /> 1, L1oes not requirc modification to electricaJ pr ga,a sorviee.
<br /> 2. f-la.�a totttl cost�f$500.00 or loss;oxcludinc the cost of the fixture ar sppliance;1nd
<br /> 3. Is improvecl,inste.11ed or replAeod by Cho homeowner or licensed plt►mbing contractor.
<br /> Skip ncxt scction,ifthis applics; Cost ofPennit � 15.00
<br /> StatC Surchsrge $ S.QO
<br /> Mail-In Fcc(1f Applicahle) $�?.pp
<br /> m�tAt r.��r,ir ree $
<br /> (Permit Fees Continaccl On Next Pn�c)
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