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-- - „� a..>.. <br /> _ ,,:,,��_.�,, ,.:: <br /> FIXTLTRE $SM.T 1 2 OTHER FT�C'C"URE BSMT 1 2 OTf�R <br /> TYPE FL FL T'YPE �, FL <br /> Water Closet ' �1oor Drains <br /> La�vatory t Sewer�jector <br /> / <br /> Bathtub Laundry'rray <br /> Shower Washer <br /> Kitch�n Sink WRter T�eate►' <br /> Disposal Water Softener <br /> bishwasher W���' <br /> Sillcqcks Miscellaneous <br /> ) �� ,"��1.�c��n���i� �� <br /> �� �� �� <br /> _ _ _ <r4i' .� ��' <br /> :.�•��-,.`t�Y?•• = 9..._t <br /> ir <br /> ❑ Yes,this stction applies <br /> The replacement of only one Residential fixture or appliance thaC meets al l three of Che following <br /> requirements: <br /> 1. Does n require modification to electrical or gas sewvice. <br /> 2. Has a total cost of SS00.00 or less;excludin the cost of the fixtur�or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing convactor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> $tate Surcharge $ 5.00 <br /> Mail•In Fte(lf Applicable) $ 2.0 <br /> Total Permit Fee $ � <br /> (Permit Fees Continued On 1Ve�ct Page) <br /> 2 <br /> S,Z:a6pd 9Z9b6�22S6I��l Zb2ZSLZ02� H'8d uos��t,�puaH weg:wo.�� Z£:0i SZOZ-LO-Ndf <br />