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C <br /> ., <,�,_..�� . - '�'/-T����,'rtra:�s_��nv�A�ST�L�A�;- ����•�,�,: <br /> -1�' ,�:0:I n'•'��,I��� }`�. <br /> �}�(�LE gSMf 1 2 OTHER ���-' B5� FL �L OTHER <br /> r�� r�. �. <br /> Wacer Ciascc Floor Drains <br /> � � � <br /> Levatory � � Sewer Ejcctor <br /> 1 <br /> Bathroom Laundry Tray <br /> Shower � Washer , <br /> Kicchen Sinl: Waczr Heater <br /> Disposal Wat�r Softencr <br /> Dishwasher Wzt Bar f <br /> Sillcocks � Miscallaneous <br /> �,.,: �.:^ •rr '�,•4�',1 <br /> � F �r ,,-�, ,.,u y �PER�I�'�E'._�A:��UI-A�P�(�3� , ��.:u> >� � ��, a � <br /> �{; ��t�i � � r,a � �M,��r{ � ,�y, d . � i �1 � .Ii i� I , -�� <br /> 'j} (�'Qj� ry '] f� *� ^� n � �� � <br /> �4� 'l�. `IV.h.`y�.��'�����t�� � r� �h'����l�Y�++�•���1+G�l.f�1-��.�1�L��fr ��`��r.�F.�������� , � 4 e <br /> Q Ycs,this srction applies <br /> The repieeement of a Restdenrial fixiure or agpliance thac meets all chi�e of che following requirements: <br /> 1. Dors not require modifieation to elecerical or gas service. �, � <br /> 2. Has a t cost of$500.00 oz tess;cxcludin�the cost of tl�e fixture or appiiance:and <br /> 3. Is improved, installed oz replaced by che homeowner or licensed conu�actor. <br /> Skip ncxc section,if this applies; Cos�of Perznit 3 15.04 <br /> Stau Swchange $ .50. <br /> Mail-Tn Fee(If Applicable) $�Q � <br /> Total Permit Fee $ <br /> {Permic�'ecs Continucd On Next Page) <br /> 1 <br />