Laserfiche WebLink
� <br /> � <br /> � <br /> 1 <br /> FIXTURE BSMT 1 2 OTHER 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 W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous � <br /> . <br /> ❑ Yes,this section applies � � ' ;,� �-. � �: � �i� , ; _t. <br /> � ��a .._ � . . .. . .. , --a <br /> The replacement of only one Residential fixture or appliance�ha,,t�n�ets a�l�hre�pf the followinjg <br /> requirements: ��✓t.� :T:. ; + .._i d�.:,`,-�.;,� <br /> 1., rT�bes�io��equire modificarion to electrical or gas service. �> �t��'; .: <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance: and <br /> 3. Is irnproved,installed or replaced by the homeowqer�ic� u�Fontractor. <br /> ... - , ��.. , <br /> Skip next section,if this applies; Cost of Pemut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> �K ���'�, ,=!'.l:1 � +.xc�r�, ,' -Ta�L.P��,l��� �3'l�Z��i�t`�r $ <br /> .,.��. . � - � <br /> . .. . , �.3� , <br /> ':`�. �t�t4\�.. �;�:'h,C� <br /> ... ;: "�' "'+ <br /> � , �c„ . i t�1� ,... <br /> (Permit Fees Continued On Next Page) _� ��` __�;��, �Vy <br /> 2 <br />