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., <br /> . <br /> ��"" T�i �..�;., $�,�f'�" ..,w�. .`�, - ���°� �` ���.: �`,&::�,# p,�f��%� '��F � ,,ia!r��. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ,2 Floor Drains <br /> Lavatory 2 Sewer Ejector <br /> Bathtub Laundry Tray � <br /> Shower Washer <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> £ �,. <br /> »,K � ^k�� �,Eq,s ,.� � z.��t n�. r"v.::. � n�t.'�,;�, °s ,�,�� ,*,._: <br /> �? �. .� {'.,,��r''� sy t s�u, s",�r` °�' �" �„'��« ...tr <br /> ��'��'" �..�`'�<�,� � �'" ��' �` ���n <br /> -*�_ „�„ <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 $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />