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' �.G S <br /> FL}:TURE SSMT 1` 2 OTHER FIY1�L'R� �SMT 1` �� OTHfi� <br /> TYpE FI, ��. TYP� k'L PL <br /> Warer Closet �'loor Da�airss <br /> Lavatory Sewer�jector <br /> Bat.hrub �,aundry�'��ay _µ..µ.� <br /> Sl�ower Washer <br /> �Citcben Sink Wafcr Hcafor <br /> Disposaf Water So�iener � <br /> Dishwasher Wet�3ar ~ j � <br /> Sillcocks M1sceU.aneous � <br /> � fi ' �-�� r.a.� ,5 _�q;+ � (� 3 �^ �{G��`�_. <br /> � ��N:� `'�'����a �� , �. <br /> :� � , � ,�- � �. .3`z�0.. yT'�;�s�,�;e ��_ � ��.� <br /> [,� Xes,tlais section applies <br /> The t^eplacement of o�nly o�ae Residential fixture or a�pl�ance that tneets a�l three of the following <br /> xequizements: <br /> �, e� t zequire modi�cation to electrical or gas seivice. <br /> 2. Has a total cost of$500.00 or iess;�xcludin�the cost of the�ixture o�'t�ppliance:atld <br /> 3. Is improved, installcd or rcplaocd try ti�c homeowner or lieensed�lurnbing contracto��. <br /> Skip next section, i�this applles; Cost o�Permit � 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If.A.�plzcable) $ ._,?.00 <br /> '�'OtaC�'er�n��t�'ee $ <br /> (Permit Fees Continued On Nex#Page) <br /> 2 <br />