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M1 <br /> i�d}'�� . � . <br /> �' .. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � i Floor Drains I <br /> Lavatory � � Sewer Ejector <br /> Bathroom i ( Laundry Tray � <br /> `�"��r. <br /> Shower W asher <br /> Kitchen Sink � Water Heater � <br /> Disposal I Water Softener � <br /> Dishwasher + Vl�e�Bar � <br /> � `�.���> >'�.t <br /> Sillcocks � Miscel aneous � <br /> 1i ` <br /> , _ . ��-1 � , <br /> .� ,,_. __ , <br /> ���._ �t;��i u.;�tsh. ,t. � � 1� <br /> �<.. �-.,� . <br /> �/ L- ���-.� �t���P� �- C.i� <br /> s�c'i n�C�.e� 1���� l��RC . �D•'�.1,���,� � , <br /> ���' _ `• \ 1' , .-i- , \ .. �,- !.. ( ;1 <br /> � _._, � __ ___ __. <br /> --.._ <br /> � ,.: � <br /> �� .PERMIT�FE� CAI;CUULA`�T�DN(�) ;� �, � <br /> f , , , �� � <br /> �. <br /> �... :. =:�_B�AS�D QF�:I� - 2002 S1A'I'E S"I'11TUE, � <br /> ❑ Yes,this sectioirapplies <br /> The replacement of a Residential fixture or appliance that rrreets 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't14e homeowner or licensed contractor. <br /> Skip next section, if this applies; Cost o`�I'ermit $ 15.00 <br /> State Surc`h�rge $ .50 <br /> Mail-In Fee�If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />