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a <br /> �.-��k'� '•� .e,�,3 �:,'::. ���"�y ,.�',����..�];a�` A�i �ea � ,9�.;. 'L'I'2if�����.tJTL'1LL.L:i� ,.`'=sY.� �..r ,, ���t ,�' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains . � � <br /> Lavatory � � Sewer Ejector <br /> Bathroom � I Laundry Tray i <br /> �� <br /> Shower � / Washer / <br /> f ( <br /> Kitchen Sink � Water Heater f <br /> F <br /> Disposal t Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> � � PERMIT FEF C�I�C�U�,AT10N(S) <br /> � 13ASED (7i'F -�2002 STATE STATI3E <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirernents: <br /> ]. 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 contractor. <br /> Skip next section,if this applies; Cost of Permit $ I 5.00 <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 />