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�� 7 �.;j��� ��sc- <br /> ��E r <br /> �zya -r�iu <br /> r� ^� �fi������. , ,.�u�= L, <br /> �.L,� <br /> FIXTURE BS�iT 1 2` OTHER FIXTURE BSI+r4T 1 2' OTHER ! `� <br /> ITYPE � FL FL TYPE FL FL <br /> i <br /> Water Closet � � FloarDrains <br /> La��atory• I � �� Sewer Ejector <br /> i <br /> g���b � I Laundry Tray <br /> � � <br /> Sho�•er � T�'asher <br /> , <br /> i---�------- <br /> � Ii3z:hesi Suik t t�'aterHeaier <br /> ! l <br /> � Disg sao 1 � Water Softener <br /> � <br /> ;D s �i h 4asher -- _~ --- �`'et Bar ---- ---- — --- <br /> ; Sillcocks �' �.::�k"�`• Miscellaneaus <br /> rr. <br /> �� <br /> ,I� � , <br /> PER.I��IIT FEE C�.LCL�LATIt�I`�1(S� ��---i <br /> L:_.�__ B:<�SED(7F�`= 2t102 ,T�TE STr�TUE ` <br /> ❑ Yes,this seceion a{�piies <br /> The replacement of onl}'one Residential fi�ture ar aonliance that meets ail three of the following <br /> requ irements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of SS00.00 or less;e�cludinQ the cost vf the fiYiure or appliance: and <br /> 3. Is impro��ed,installed or replaced by the homeavvuer or licensed plumbing coniractar. <br /> Skip next section,if this applies; Cast of Pemiit � 15.00 <br /> State Surcharge � 5.00 <br /> 1�Iail-In Fee(If Applicat�le) S 2.00 <br /> Total Fermit F ee 5 <br /> (Percnit Fees Continuetl Qn':��et Page) <br /> � <br />