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\ <br /> � I <br /> ,' : PLUIVI��TG�I,XTURES$EING`�TSTAI:�ED ` .' ..';- � - <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 Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal r Water Softener <br /> � <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous �� <br /> ` f���'14�+ -t,�a��`eT`�6 '"�"•a.i��q 1 � � �� ���;q��� ��'�+t w�'. � 'p�„-} a {� �ak�5 <br /> ai h i r e:��. <br /> j :1 c �'� '�„k`y5,-x �� � �h� .� • � � � a k s.��. <br /> � a��� ,� ��� �`��k�����p,,j�a x-�t � �/ s*= z�!e�,'-' �'t�j.y� ��-�.+�1 �rt� '�.�' � � � <br /> �� '�ad,�-,'..y sa'�rt¢,+�'r� `��a�Y�,',-;s�c��`s�`k,=3G7�?1���� ,�^�`���1��������.L:��' ",v� "'y,.,,�#�F �� .., . � _:„�``��''�� '�,�.}'��.. <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 mod�carion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding 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 Pernut $ 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 />