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� ' r�� Y:' F :..,: , , . <br /> r/�.���'..:�:,��,�s y... P,� .z����. N 5�"�� +a. <br /> � G;; <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Fioor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> , S� 9�t.,;ts � \°�a�,�.,fi'�" �TM" 4'�`*; <br /> �,�,.� v _ �� � i . � <br /> . ��:�. � .:.: : ,? a 3 ���. a..� <br /> � ,. <br /> � yz �-� '3 . h �;��,.'� �� ��`s`�.Yi� <br /> :, , � •, �'�:rc.. <br /> �i�.. ,�'- #.: '�'"' u <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 modif cation 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 Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ I? �c�b <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />