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� <br /> � 9 � <br /> �¢,,._ � � 4�`a�:..� `ry 5�,.� �' ���.�9..�����,tp'ar.�'<'��,"�ti�R'�'��.cr�"'�:: <br /> ,_�'� r f���.���-.� ���`.7: _ �`$;�fi+�� '�:��::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 Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � �s �` ,t„ �r" � '� �:t xrK��,v.� <br /> �� r �„ y q ��,e 7 �' R �� fa�,s�����j�� <br /> . .� ` � .� ,. � � <br /> f � <br /> � � d <br /> . ���,P... dSa4: 5� � � .n'�.'�'�Afa. �i�Yn� .�`, m. .�7"{'� <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 modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine 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 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 /> 2 <br />