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....:. ...::..:::.::...:. . .. . ... . .. . ....... .,, .. ,. .......::.:::.... . �..� <br /> ;,::�::::��<<;.<;.;::<;�.�<.>.;.�<:«<:>.:>;:>;;<'� � ;..:�;;.<;a:<��:<;>,:<,:<„;.�.�K<�<<;<»:>;:; <br /> �>.:;.;;.`�z:.�,,;.<•,,.,;,.;...•:..,,•.�;:.�:•: �� •`•.:•z,t..nxf�3;Zwt��s:x��.{:•�. � �•.?'�a <br /> .•::<,, ;.<,c.a,:sz��ra:z.•<z«.�^�: � <br /> FIXTiJRE BSMT 1 2 OTHER FIXTi.JRE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom La�mdry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � �����������.������ T <br /> � ; <br /> �<������3;�������'.�.'`��"�'.z�`�'�� ' <br /> . .> ::.::W::::.::::� <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;excludinQ the cost of the fixlure or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if ttns applies; Cost of Permit $ 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 />