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a;��cf :?xm 5��� "�r <br /> . <br /> � � < ; � x , � � <br /> , � r , <br /> . �< . . ..�.�: .s- �`�`x�i <br /> � ,.. ._ . , _,----< .. _h� ��# ,.,.�.k.���� <br /> FtXTURE BSMT 1 2` OTHER FIXTURE BSMT 1' 2` OTHER <br /> TYPE �L FL TYPE FL fL <br /> Water Closet Ftoor Llrains <br /> Lavatory Sewer Ejcctor <br /> 8athtub l,aundry Tray <br /> Shower Washer <br /> Kitchen Sink Wacer Hester <br /> Disposa! Water Softener 1 <br /> dishwasher Wet Bar <br /> Silicocks MisceJtaneous <br /> '��� <br /> �' �� <br /> ��.��� ' � <br /> �,... ��.�� :���x <br /> [] Yes,this section appGes <br /> The replacement af ooiy oneResidential Eixture ar a�plaance th$t meets all three ofthe following <br /> rtquiretnents: <br /> t. Does not requirt modification to eEectrical�gas service, <br /> 2. Has a t taa !cost of$500.00 ar less;�ci i 'n the cost of the fixture or apptiance:and <br /> 3. ls improved,instatled or replaced by the homeaw»er or licensed plumbing contractor. <br /> Skip next section,if this applies; Cosc af P�rntit $ is•OU <br /> State Surcharge S s.oa <br /> Mar1=1n Fee(IfApplicable) $ 2.U0 <br /> Tota1 Fcrmii�ee ��z'.00 <br /> (Permit�ees Continued Qn Next Page) <br /> 2 <br />