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_.�___..._.�__� .._...___..__--.---____ �,_.__.._._ _� ,___.__ __.._---_._.._.....�.._—___ <br /> PT.U?VIf311�IC FIXTU��BEII��IAiS"l ALL�,I) _ � <br /> FIXTURF. BSMT l� 2 OTHER FIXTLIRE BSA�T l� 2' OTHER <br /> �'YPF. PL FL TYPE rL FL <br /> 11%a!er Closet- ---- -� � Floor Urains T_ � ---�- <br /> � � i _�___ �__�� <br /> Lavatory " / Seever�,jector <br /> �� <br /> Bathtub � � � Laundry Tray ' � <br /> _ —�- -- � <br /> Shower f � / Washer / � � <br /> Kitclien Sink > Water Heater � <br /> / � � <br /> E <br /> Disposal / � ��v'ater Softeii�r �` � i <br /> �C)ishwasher � ! 1l'et E3ar �� � i--� <br /> — � �—�- �. �------�-�— �-- ' <br /> O � <br /> Sillcocks ' l � Miscellaneous �� � � <br /> __���1__�1._ -- � --�_ <br /> -_----_ ----__ _______--_---___ <br /> , - _ -- _ __ _ -------__ _ <br /> _____-_-- --__ <br /> � t'(�;t��2➢ 1 i-��t, t�rii� �;L,«1 �t�h,�;) � � - i <br /> �---- -- � f3�.SE1�t}FF' 2€}�2�S I�AY F ST��I t)E _--_— �_----- � <br /> ❑ Y'es,this section a���lies <br /> The replacement of only c�ne Resic��ntia? fixture or eppliance th�at meets all tl�ree of the following <br /> req�irements: <br /> 1. Does not requir�modificatiou to electrical or gas service. <br /> �. Has a total cost of$SOU.��or less;excludi»�the cost o#the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next sectiou,if this applies; Cost of Permit �_ I 5.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $_ 2.00 <br /> Totai Permit I+ee $ <br /> (P�rmit Fees Continued On Next Page) <br /> � <br />