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<br /> FIXTURE BSMT f 2 OTNER FIXTURE $SMr t' 2 OTHER
<br /> TYPE P�. FL TYP$ FL FL
<br /> Water Closet � � �loor Drains I
<br /> �.avatory � � Sewer EjeCtOr
<br /> Bathtub � � T.,aundry Tray f
<br /> I
<br /> $hower � Washer �
<br /> Kitchen Sink J Water Heater !
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<br /> Disposal Water Softener �
<br /> Dishwasher r Wet Bar
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<br /> Sillcocks � Miscellaneous
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<br /> � Yes,this section applies
<br /> The replacernent of onty one itesidential fixtu e or a liance ihat meets all three of the following
<br /> requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a total cosc of$500.00 or less;excludin the cost of the fixture or appliance:and
<br /> 3. Is improved,instaqed or replaced by the homeowtler or licensed plumbing contractor.
<br /> Skip next section,if this applies; Cost ofPermit $ 15.00
<br /> State Surcharge $1-QO
<br /> Mail-Tn�ee(If Applicable) $ 2.00
<br /> Total Permit�ee �
<br /> (Permit F'ees Continued On Next Page)
<br /> 2
<br /> 9,S:a6pd 9Z9b6bZ2S6���1 LbZ�SLZOZ� H'8d uos���.apuaH wpg:wo.�� ZS�ZT SIaZ-80-1�0
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