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6� �. .� ___ Q �� <br /> '�.�. Y,.r�"x,��. ..� - ..:kT F ,.-... �"..{� y���C7'�}��..�D�ff F�Er J 4°t <br /> FIXTURE BSMT 1 T 2ND 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 /> t� ' �`+�9 �w. '. '�.tv°��'l° ,, � �Y "„""` r �n� � �. . <br /> � . a Lys� h�1�� ,�ti ��g�"i4�� �� t��� �1� r � �t+.��S`��, ��rf it� ��.��a����+�y��. <br /> �+ v h 4'L '�`LM r'z,G.N�"i. �}��i �1�, fk�7��-t � �`i 'i'('` M- <br /> ��- � h« � 3s"»� a �� �, .r. <br /> `� ��a� ...R'�e4.. nta i'�C,Mv z�� 'r�� �r� n �t,r. ��' < <r,���a'.��"�,�{�'^�s. <br /> .._. ., ,i............... . ...S n ...,..� . .' ... ... .. ....!t:x ..�1,...q!1. .. <br /> ❑ Yes,this section applies <br /> The replacement of only one Residenrial fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does 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 or 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 $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />