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h Y11�, ( <br /> �.`� { y ;::'�Zr � ;:�r�Kt�fk�_', �+'� r '.r� <br /> FIXTURE BSMT 1 2 OTHER IXTURE <br /> TYPE FL FL YPE $SMT 1 2 OTHER <br /> FL FL <br /> Water Cfoset � 1 <br /> J_ loor Drains <br /> Lavatory <br /> � � ewer Ejector <br /> Bathroom <br /> � 7 aundry Tray � <br /> Shower <br /> ' � asher 2 <br /> Kitchen Sink <br /> � ater Heater � <br /> Disposal � <br /> ater Softener � <br /> Dishwasher � <br /> t Bar <br /> Sillcocks � M scellaneous <br /> i.�;�i5h, .�.- <br /> i <br /> k i;} <br /> !v``���k��� u's+�j ry t�r��fF'�;�;�S�"����4��i,n , r 1�� 3�',���'!,'; �F K��`,�:�Qr v <br /> �i m i, lt �;, ,,,�� ��.�e ' <br /> • , � <br /> � : ,1��" s,���s�� '"'`' ,�'��� "��,���������Q � ��'� �'; +u dtl��fi) �t i 4 s <br /> — � � `��1 r �' ": �`�'i <br /> -- - :._ __._'l� �� -�.��,���� �. 1a,,; � <br /> ❑ Yes,this section appl'ies <br /> The replacement of a Residential fixture or aoaliance that m ets ail three of the following requirements: <br /> 1. Does not rec�uireimodification to electrical or s service. <br /> 2. Has a tota(cost o,f$500.00 or less;excludine t e cost of the fixture or appliance:and <br /> 3. Is improved, installed or replaced by the home wner or licensed contractor. <br /> Skip next section; ifthis applies; Cost o Permit <br /> $ 15.00 <br /> ; S�ate S rcharge $ .50 <br /> Mail-I Fee(If Applicable) $ 1.50 <br /> Tot�l ermit Fee $ <br /> � <br /> i <br /> (Permit Fees Continued On Next Page) I <br /> 2 I <br /> I <br />