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01/18/2013 09:34 651 948701 JANECKVPLUMBING PAGE 02 <br /> � II <br /> I <br /> � <br /> � <br /> FIX'RJRE BS 7' 1 2 OTAER �IX'�'URE SSMT 1 2 O'fE�'sR <br /> TYPE �1.. FL TYP£ FL �,L. <br /> Waeer Closec � � Floor Drains <br /> Lavatory ` .� Scwer fiject�or <br /> Bathtub r Gaundry'l�ay '! <br /> � <br /> $hower / Washer � <br /> Kitqhen Sink � Water Hcatcr � <br /> r <br /> .,. ,. �_:,.._. . _,�,�r -�� w�ter Sa�er - - , <br /> _,� . . Dtsposal _ - <br /> j <br /> Di�h.washer � Wet Bar <br /> I <br /> Sillcocks Miscellaneous <br /> I <br /> ,�� _ <br /> _ ._� , <br /> k . . <br /> r ._ <br /> �� ._.. _ _ <br /> ❑ Yes, is sec�ion applies . <br /> .,.._ . . . _ _ <br /> � ,'f'hf replacem t of o�ly one Residential fix�re or aQpliance that meets all three of the following <br /> � ireme�nts: .._ _...._,. <br /> 1. oes n require modification to electrical or gas service. <br /> - _ . <br /> 2. Has a tat�of 5500.00 vr less;exc udin the cost of the foct�ire or applian�e:and <br /> , _ 3. Ls improvvd,instslled or replaced by the homeowner ar liaensed plumbing contracbor. <br /> y _ <br /> S p next sectidn,if this applies; . Cast of Permit _ $ 15.00 <br /> .,-..--..-�--,.—.. _ <br /> ., ., Staie Sw�charge S 5.Q0 <br /> Mail-in Fee(if Applicable) $2.00 <br /> ...... .. .. . ._ ._ _ . __. __ _ _ . <br /> __ --. _ <br /> To��Permit Fce S <br /> (�ermlt�+'ees COotiOped On No:t Page) <br /> . .. � . . .F�„ ',Y..... � ` . G <br /> �i ,,.,n, �f u,,r� �,, ;, ,_ <br /> c,r., .. . , . <br />