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FD�TURE <br /> TYFB BSMT 1 2 OTM FIXTCTIZE BSMT 1 Z FL FL TYPE <br /> 1rL YLOTAER <br /> Water Closet <br /> I Floor Drains <br /> Lavatory <br /> I Sewer Ejector <br /> Bathtub <br /> Laundry Tray <br /> Shower <br /> Washer <br /> Xitchen Sink <br /> Water Heater � <br /> Disposal Water Softener <br /> Dishwasher <br /> Wet Bar <br /> Siueocks <br /> Miscellaneous i <br /> r <br /> 4 lip. vE. <br /> 5Ern.£,py��u+aM .. fN ,�• .±Y.. � r�—��!' M lea'•' ��� •• �.i.1P��tl •Pp'rl•. . <br /> 4 � • • r �P1�f�{I���p�'',r}y��•r •J> u0.r. <br /> � '��Q/ �� �4r�"r4•ai'lU ti4'' 't'• a r. <br /> ❑ Yes,this section applies <br /> The replacement of only ane Residential fixture <br /> requiretnents: ora 'ante that meets all three of the follow' <br /> ni <br /> 1• Des not rewire modification to electrical or gas service. <br /> Z. Inas a t o0 of$500.00 or less; 1 the cost of the fixture or <br /> 3• Is improved,installed or replaced by the homeowner or licensed plumbingimme: r. <br /> Sldp next seeticry if this applies. Cost of Permit <br /> State Surcharge $5 .00 <br /> Mail-In Fee(If Applicable) g .00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next page) <br /> 2 <br /> 00/60 30Vd OSZZ 360iS Shc 3Hl BV09TZV69L LO:60 TTOZ/00/00 <br />