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?. <br /> � � <br /> � +.ys :�.s 's� �^ v 73 :��: <br /> :�:�r �� ,�� r�%. � �F-.�*r. - ����� � ��s w ,..,r�,���,�,�R„��' � '.��.,.: <br /> -;.0. „�`s <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 � t � Sewer Ejector <br /> 1 <br /> Bathtub � Laundry Tray <br /> Shower t Washer � <br /> Kitchen Sink ` Water Heater I <br /> 1 <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � Miscellaneous <br /> ��� � ,�,�� �;: _ , " <br /> ��, � <br /> . . _y , <br /> �� ^ p' <br /> � '�}� .�' �.fo: <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or a�pliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to elech-ical 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 $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />