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t .. <br /> ' . <br /> { . <br /> ;�4'.;i�' t y 2 +} n �sG� s.,.�.5 �J.L�B`Ii�G FI� ���� � �111-1�:.+��.i`f��''a �`C t p��ri'. �#*°r :�_ <br /> ,� �:�� ;�. T't�r_ G`'�:T� *. .+. .�� ,�; �. <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 L Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer / <br /> l <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> :��.fr.F' v P '4'�c y�y '< a +' ^v�#� �i r,.. 4 wt .� xsNt r <br /> � F� ���.� � x��.;�� �� ,������r,���T'R��C�I.0 'A � � YI � � t��� �� ���`� ���'� <br /> �����' a"� �'�;�:�`�'�' �' e .�`a"�[A�p -�.r�u1 , r ��(��� ��� ���(1�,�e �+���t�A���+� x 3� �i <br /> ,'�'iE�.$''�ig.�,P--�.,� �j.`r.ir. :�.:'Y��.Y�17`i'i�y��L�� ���2 l7�!��xLl�`al���7a£ ::K'����}. a��`�4`'`C..,�:�t'Y���'`����'.�� <br /> ❑ Yes,this secrion applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification 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 /> Sldp next section,if this applies; Cost of Pernut $ 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 /> '� � <br /> � <br /> � _ � <br /> ��i f, <br /> � <br /> 2 , � <br /> � ;� ; ��` e, <br /> ' a � <br /> u ,� K <br /> ` 3 • I � � <br /> r � . " s . ' t;, . � � � � �� �; <br />