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ti <br /> - — _---- — --� <br /> � P[:Li�,���3�NG �=tXTL'1sES �-�3r[ivCrINS�'f?I�LEL3 I <br /> FIXTURE BSMT� 1''� ` ?�� � OTHF:R FIXTURE � BSMT 1� 2`�' OT LH R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ' Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal ' Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks Miscellaneous <br /> �1���,F . PECLI�TIT FEE C;ALCCII,ATI�NiS j ; <br /> � �u��,�� � �' B�.SED tJFr -?Ot)Z 5T�"CE S`i'4TUE _�� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fiYture or appliance that meets all three oT the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$�00.00 ar less;excludine the cost of the fiYture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if Uus applies; Cost of Permit $ 1�.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 />