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►� <br /> � €.: � �� , ;.�..P.I;UMBIN'G�FIXTURES��B�]NGr;IN�TA��.L�U`� ', ' ' r �, _� <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 /> � <br /> Dishwasher Wet Bar <br /> Sillcocks iscellaneous / <br /> /',u�r.+� <br /> C�.- <br /> 4€ ''"r. �.� ��'"� ��"a'w�"�'��a�� "�'c�'9�f"�a5�������L'�.L�.�i:� �yLO121���'`-a�'�{�iia`^'���`�fi��,�} �Y 5�4j.�.f'�f�: <br /> •F - . d GM j +{ ,,y, k a+t � �. 'w t � � J �S � _ rV ti.k% <br /> `��''� a �N f �xE47 .C��t, � v r� t'� r,�.,� � r� a ��� � „��.� f,G�24 <br /> r�';4�r:,���`�}��? �, ��,���,�� ;����i�s�r�Q� �Q����.t��".���f.��?�5!��;�y � ,e,� '�..�"������: <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requuements: <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 fixiure 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 />