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� <br /> i <br /> �t <br /> r;; ' <br /> `` � PLUlY�BI1VG,��IX�'�RES°��ING:INSTAI;L�D ,. =;,:F �..w' 4.�,._�� : . <br /> �:.�:: �, � , t,� . � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OT'HBR <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains + <br /> I <br /> Lavatory j � Sewer Ejector <br /> � <br /> Bathtub 2 Laundry Tray ' <br /> ..J <br /> Shower � W asher <br /> Kitchen Sink I Water Heater I <br /> Disposal I Water Softener <br /> Dishwasher + Wet Bar <br /> I <br /> Sillcocks � Miscellaneous <br /> � 1 ��S,�},,, . ti +n��'���mr 7' 1 r "t4z�.n, 0 ��'+F.s�� � . ,t y, <br /> �c s a ��'''��- �'�'�''",+��� :�-,:�k��+k�r"'��{#�������'��0��►�Y`*'��4J,.� i F{,e 5��j" ..� r F} ,:�{ <br /> �f.�a u ^, 4 u +x t� :.'�ai f� <br /> �v �''#' p��7���F'� . Y�Y� � �$��.`�.�,., K'(�y�t rc L t�ry' �R ��`' �S i�"�si ���">k � .��r� �k�,..� �t . <br /> T''I#3�.,,T�` 2f6�4'- ��q��; ;'�'v+��.t`117i1���'� li.��is.��.��.�5.'.., .�,���`:�_.4 s� 2� y�`ts ;'r"r1•., :A:. <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;excludina 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 />