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, <br /> V , 'z �� ��.,� .`���%�+ ��.„ <br /> FIXTL'RE BSM'I' 1 2' OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ! � Floor Drains � <br /> � OG� <br /> Lavatory � Sewer Ejector <br /> Bathtub � ' i Laund.ry Tray / <br /> Showec � � WashPr I I / <br /> / � <br /> Kitchen Sink � � Water Heater / <br /> Disposal � � Water Soften�r , <br /> � <br /> Dishwasher Wet Bar / <br /> l i <br /> Sillcocks � Miscellaneous / <br /> � <br /> i -_------ - -- r�;`; v:; �.; ; �::��1.. _:'.��-���C3�1{�}.___ _ i <br /> �__�_._..__�_.�� __�� ;.��'�� �,}�"�_�2�X17 ai,"�� �'�'�."€��.?�. �_ _ _ � <br /> ❑ Yes,this section applies <br /> The replacement of only one Resideniial fixture or appliance that meets ail three of the foilowing <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost�f$500.00 or iess;excludine the cost of the fixture or appliance:and <br /> 3. ls improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ 1.00 <br /> I�1ai1-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />