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...,2;; �s:rr,�,','T,�tr � � ���`a�rz'..4 sd" �� �jn�.'�'S <br /> FIXTURE BSMT 1 Z OTf�R FIXTURE BSMT 1 2 O'Tf-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet f Floor Drains <br /> � <br /> Lavatory Z Sewer Ejector <br /> Batln�eai� I Laundry Tray � <br /> Shower � Washer ' <br /> Kitchen Sink 1 Water Heater <br /> l <br /> Disposal Water Sof�ener <br /> Dishwasher ` Wet Bar � <br /> Sillcocks Miscellaneous <br /> � � <br /> � ,,�S ���� <br /> y%. t�. _y h��C�ty�.,r,".� ' Y�'m°,��JV ,r.,.: �..,• �w4"4t'-� �� "�"F��. x'�� aF`# H:: <br /> � i� ��..':. ;�-: ,w, <br /> .�.� s ��sw. r.� � �.�x'`?3',.. � � ._.a � � � _���_....'N'-'�r,�' . '.�.i"�'7,�:` �...�`,e_�. <br /> � � <br /> �.. .,�_. ...a..., ..< . ... . ... ...,...,, <br /> ❑ Yes,this section applies <br /> The replacement of a Residc�tial fixture or a�oliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical a gas service. <br /> 2. Has a to cost of$500.00 or less;excluding the cost of d►e fixture or appliance:and <br /> 3. Is improved,instailed 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 Neat Page) <br /> 2 <br />