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� <br /> _ - <br /> s�."' `., �5¢: xc4,-2:..`i<:ti:i%:[;::2:`.;%,Z:- <br /> `: a����.�' •:a,.'�'t' t.µ:. <br /> _: .. �-.....- .-. �..>....� <br /> . .• - <br /> .�... <br /> _ � • . � � <br /> , . . <br /> . <br /> - • t <br /> .: . . . . : . • . - � ' <br /> �:................. - £` �b.":�. ';.�: <br /> I�IXTUI� E3SMT' 1 2 OTHFR FIXTURE BSMT 1 2 O"fHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains � <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower W8S� <br /> Kitchen Sink Water Heater <br /> Disposal Water 3oftener <br /> Dishwasher Wet Bar <br /> Siilcocks ������ <br /> ti. � I ri�� ��`� ,✓`,S �1 Cf L�-1 f �� ►�f � <br /> LJ�'� ��r.- � � <br /> �������������z � � <br /> �_..�.......w ,.__. ��.����:����_�`�.�.����'�'�:`�� �.....,.....M.Y.....ww_._.._..._..W� <br /> ❑ Yes,ihis section appiies <br /> The repiacement af 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$500.04 or Iess;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved,instalied or replaced by the homeowner or licensed contractor. <br /> Skip ne�ct section,if ttris applies; Cost of Permit $ �5•� <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Apglicable) $ 1.5� <br /> Total Permit;;�ee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />