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f <br /> . . � <br /> -.#j^t. �is j 4:t,S' :'.. �, �.s <br /> H 4+.��9����*�'y� F�'�,�t�E� �.i/���.�i������������4 �'�'� ,.ta.�,.. 4 �i,�.,�� y����. <br /> -h a"3 t '�aP' 1.L 2 �r f ., <br /> ,.��.,�'.Y."iG..., ..�,r <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscell�e� � <br /> � <br /> , �� � �p�. �. , F r� � � � � ��a e �'�+€�+r�.� <br /> ,y�,?i.e . t '� 4�` x � 4 i '� �,�a ��'0�,�N�_.� �:��y� �".''�4a7 �'. <br /> _.�_ .v�. r � k� � � � �E...._ 1�``." �� � f0 .��a^.0 �ti. � i��.� � J:� d3'o'�,d i-��: <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />