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.` <br /> . � <br /> . ..�i,W �V..iL'��-'�.1a/}1Zi����, �"r�il11" w� � i <br /> T�•4t � � <br /> FIXTURE BSMT 1 2 OTI�R 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 Water Sof�ener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <br /> , < - ,_ <br /> ��. fi " -�.s°' � � � <br /> �. �^ �;�„�l��r� ��.-�;�' K�TM .F,is�r �"�'��. �_ �''`'�'r �,�,�;',* <br /> l "t �.:, ¢� <br /> �n � j� 'G _ ^� '� .i' .k ct.�=�� <br /> at <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 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 Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />