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07/13/2011 10:48 6127246656 TEAM MECHANICAL INC PAGE 02 <br /> FIXTURL BSMT 1 2 OTHER I�TXTURE BSMT ] 2 OTH�R <br /> TYPE FJ. FL TYPE FL r[. <br /> Wat�r C�oset Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub i.aundry Tray <br /> 3hower Wagh� <br /> Kitchen Sinlc Water Ncar�r � <br /> Disposal Water Sofi�cncr <br /> Dishwasher Wet Bar <br /> Sillcpcks Misccllaneous <br /> ❑ YeS,this section applies <br /> The replacement of only one,R�se ide�iti�l fi�ture c�r appliancc thst maets ail three of the following <br /> requirements: <br /> 1. oes ot requirE modification to electrical vr gas scrvicc. <br /> 2. Has a al co of$500.00 or less; lu i the cost of the fixture or appliance:and <br /> 3. Is improv�d,installed or replaced by the homeov►m¢r or lice�ised piumbing contraetor. <br /> Skip.next section,if�this applies; Cost of Permir $ 5.04 <br /> State Surchargc $ 5•00 <br /> Mail-Tn Fee(If Applicable) $ z,pQ <br /> Total Pertnit Fee $ <br /> (Permit Fees Continued On Next 1'agc) <br /> 2 <br />