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� <br /> .Y� r-._,. <br /> 'i"y���cr'y.�y�'s�,f�cAry�6��` � ' � �5421� � 1i. . � .� ti � �t�.?5r4��a�t��l� �`���i�aM xi,'h�l��tt��, <br /> ���'v'�+'Mt'rl:i.�wi'S%��i�hi��� .�'v`:bY•. .. . ..��...... ... .. . .'_Y.'„�. ... ,,,,..� .. �� ..1. :.A <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTT-�R <br /> TYP�, FL FL TYPE FL FT� <br /> 'Water Closet i J �loor brains <br /> � <br /> Lavetory � � �r�z �o�� / <br /> rrr �lI M <br /> $atlttub � Laundry Tray <br /> Shower ) 1 Washer � <br /> ! <br /> Kitchen Sink Water Heater <br /> bisposal Water Softener <br /> b'rshwasher Wet Sar <br /> Sillcocks Miseell�neo�s / <br /> ��J / <br /> - ���I�'�`�'�-�l-��C�..CL�1 t��'��AIf��; - <br /> r= - - �:��F����< �f)t3"��=A�'� ��A�U�, �• - - <br /> ❑ Yes,this section applies <br /> The replacement of only one Resident'al fi u o a liance that meets all three of the follow'rng <br /> requireinents� <br /> 1. Does noc require modificarion ta eleetrieal or gas service. <br /> 2. �Txs a TptB�CpSt of$540.Q0 or less;excludin�the cost of the fixture or appliance:and <br /> 3. [s improved,installed or replaced by the homeowner or lieensed plumbing contraCCor, <br /> Skip next section,'rf this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-Tn�'ee(Tf Applicable) $�� <br /> TotAI permit�ee $ <br /> (Permit Fees Continued On 1Vext Page) <br /> 2 <br /> giS:a6pd 9ti9b6bZZS6ti��l ZbZtiSZZaZ� H'8d uos��?.�puaH wes:wo,a� LZ��Z SZBZ-ZZ-83� <br />