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�l� ''�. i � �.'� .��. S"��.'�x ������������ �k�� E ��, n�a €� <br /> \ � <br /> _. . ...w� _,_,...�a• ._ ��. ,._ _ ... � ,.x, a::: _ . �:� <br /> FIXTURE BSMT ] T 2ND OTHER FIXTURE BSMT 1 T ZND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory 2 Sewer Ejector <br /> .J <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener / <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> � � PERMIT�-F�rt; �ALCUTlA'TI�ON(S) <br /> �,ASED OFF - 2002 STA"I'�� STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine 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 /> 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 />