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. � <br /> ,' � <br /> <- . , : PLI�ING FI�T"�JRES BEING;�ST,ALI;ED �::` �: <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I Floor Drains / <br /> Lavatory / Sewer Ejector <br /> � <br /> Bathtub .._ Laundry Tray <br /> Shower'�'• . � / Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �" � .z� o- �� x'"fi��` � � a �`���u*v`'�`e.'��'' k i '�' �:��i�'�'m't3�a, <br /> '� � �`��i�������- ��,r ��-"x'� e� ���y�� '�' �.�a �� `t�+�? �*'f1'y,�H �S 3"�d`;�zst ���'t �«�. . <br /> � .r. <br /> v. ,� � � �+ 1 t p § ta �a`� �{E _"'S � ��,t ,,. <br /> ���.�.�� r ����,�������b��'`�`����'T',�'����.' � ,:�-��xk: .� � ;��� <br /> ,: <br /> , � ,���� �:�: ��,� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modificarion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />