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���,X,��.�_ r •_ _� � �+fi�a"�`,;i{E���c��'�,�'�..'�r�'�i;�,h t <br /> �, <br /> FIXTURE BSMT 1 2 ° OTHER FIXTURE BSMT 1 T 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater J <br /> � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � �t ��y„ a u ,u... _... .. .. ,. ,� . <br /> if� �� -�. . ' ��s � an 't � <br /> h � � t ``»x� r �� . +�' . � �.iC��, �� �i i t G-.Y ��n"�'�. <br /> rtrt�'��g�z�„� ' � Yd �W�,'�k�7� e �p;a� G ���F� f � ��1+�����'� <br /> .:.. <br /> .,s.,:`�k;� �,�".7 . . .. _ e�.+ ,�u.. , ......� ......'. �. . � . , _.,.... , �..,,?! �P�'R��, a1•a+'�C-2; ��� �i���°�,7?n: <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />