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• �3�.,,� X`�� �r,'��� .i.�Y�r �� n„ di� ,�:'� r;a; ��+��r� � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE - FL FL <br /> Water Closet � � � Floor Drains 1 <br /> Lavatory 1 ( � Sewer Ejector <br /> \ <br /> Bathtub � Laundry Tray <br /> Shower ( Washer 1 <br /> 1 <br /> Kitchen Sink ' Water Heater � <br /> Disposal I Water Softener <br /> Dishwasher Wet Bar <br /> � <br /> Sillcocks Miscellaneous <br /> L <br /> �������,��. f G i ��� r�. �� � ��'��, �� �� S Y�� , <br /> ` �„�'il-3 � .�, �� . . . , � , � a�' y,� $�� 1 ;�3 z � °`k a;'�. <br /> ` ��` �:�.��_ �f�.y ,� ', , `", a�' ,. ., �;,:., s•s�; u.t ,� �.s�,,z,!.��r',:+ <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or a�pliance that meets all three of the following <br /> reyuirements: <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 />