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� <br /> , � ( <br /> � <br /> <' :. P.LI3IVIBII�IG<FIX'TURES BEING`INSTALLED ` �: :,. <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 Washer <br /> Kitchen Sink Water Heater f <br /> ( <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 5a �1. �.t�.�Ty'�L. ^ WES� c,scn L\ " (UDtCer �I(.c.. . <br /> rj � s „��r.5 � �au � ,, (� n &�� ,� a'-°� �'"F-�'� � t E`��a . <br /> x�r �� r{�d�a�,��"�e.�ar�.�� �� e�r� �����".r�,���������;� � x"� ,�sN s'"�� ��,��'� �R �: <br /> �i. M1N z�t �A r..:� � � �r ,� f�.,„ ,ras;� x- <br /> �`�T �} •a -�•'v ' a 1 �. ,�'�' ` �t � �}�t- ,.�t ` , a9 t S� n , f �"� "� �' � <br /> �$` fi"'��Z���h S�'�°i ,�7�'�,r�� �'n.'�''���E���.�"'��.1��vJ'fi��"��"�4 ?r,�t_,,,H, , . .4 �.'�` .1 ta,'� ..�y, dz��: <br /> ❑ Yes,this section applies , <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <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 fixture 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 S <br /> (Permit Fees Continued On Next Page) � <br /> 2 <br />