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a,��c`.�`- �`` �,� "¢ � ����, ��:l � ,��� <br /> ,..�„�,,,, . � � <br /> FIXTURE BSMT I ZN� OTHER FIXTURE BSMT 1 T 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> , Lavatory Sewer Ejector <br /> . Bathtub Laundry Tray <br /> i Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sil lcocks Miscel laneous <br /> d�, a �' 3 ��:: �' uR r�/, „�. ������ � �',�t �\ __ � ��� �� 5� <br /> � � <br /> �` � . � . � �3�'�'�' k� ., ,� � t� � <br /> 5��� SS s'/� /% 1*i A' <br /> f �-. Y4��. / �� ���� ,�'� �`��.�,�� F,,,"� � k <br /> x„ <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. Dces 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 ar 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 />