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i1/2a/z015 xvE 19: 95 FAx 6i2 822 5a08 r�' b KAbter plumbimg �403/04a <br /> � ' Id�'�� ' � �i��' ;5��,",� E�JiI��`���`�I f�171if�i�N�l1f�'Gj <br /> rixruxE BSMT �� 2 0'�R FIXTURE BSMT � 2 OTHER <br /> I TYi'E FL FL TYPE FL FL <br /> i <br /> � Water Closet Floor Drains <br /> � L1vAtory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen 5ink ater Heat ,� <br /> Dispossl Water Softenet <br /> Dishwasher Wet Ber <br /> Sillcocks Misccllancous <br /> s <br /> ❑ Yes,this section applies <br /> The repIacement of only onc Residential fixture or a ' ce that meets al]three of thc following <br /> requirements: <br /> i. Do�not require modification to electrical or gas se ' e. <br /> ?. Has A totttl eost of$500.00 or less;excludine thc cost o c fixturc or appliancc:and <br /> 3. Is improvcd,installcd or replaced by the homeowner or licei d plurobing co�tU'actor. <br /> Skip nexl section,if lhis applics; Cost af Pcrniit $ 15.00 <br /> Srate Surcharge $ 5_00 <br /> Me;i-�rCC�irAppi►�biC� 2.00 <br /> Total Permit Fee $ <br /> (Pcnuit rccs Continucd On Next Page) <br /> 2 i <br /> � <br /> . . __ . _... . <br />