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04/21/2014 12:27 FA� 9529335049 Ciil.I.iGAN MNTKA �003 <br /> �. � <br /> _ � ��.u�nvG���s B��rG�,sTAZI;i�D, , ,. . . <br /> FIXTURE BS'vIT 1 T 2' OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower W asher <br /> I <br /> Kitchen Sink Water Heater <br /> Disposal Water Softaner � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ,i�,�:{sr r����}-����, �� P,ERMiT F:�E CAI�C`UL:�TIO�,=(�) ;� ` �� � {, s, '; <br /> -���%1:��'��`�:��"` ���rk :,,� BASED OFF—.2tlQ� S�'�i`I�S'�'ATUE, �x� , ;, , , � , ,,E` <br /> � •; <br /> ❑ Yes,this section applies <br /> The replacement of a 12esidential _fixture or appliance that meets all three ofthe following requirements: <br /> 1. Does not require modification to electricaf or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3, Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> 5tate Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br /> � <br />