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/ � ♦ <br /> r <br /> ► <br /> x <br /> ��� �,. �"�r_ � i_�3 � g" �f �, y.�,�, �� k a�'. <br /> .�� �.� zg._ .�i a. 1„ e� r,.�`k�'' ,T?�.S.,Y�{•� <br /> FIXTURE BSMT 1 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 � Washer � <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ���� .�r.�� � ��.. a z �� �.`".�,r . ���,'�„� '� � e'� �.t¢ �`:r �v� <br /> � ,� s� �r �,� <br /> s�'���'� �„ �s � ��"' �%� � ��;.;u»� ������ �"� �����'���� <br /> �� -�'rr� �, r '2,`�� �qa ���!�� .A� ��°a �. <br />.z.� �::+� 7�.�;,, a"�,�s��.����'�,�: a4�, ..�'.4 th �u<;r -��" k <br /> e�r,. �,« n'� <br /> ❑ Yes,this section applies <br /> T'he replacement of only one Residential fixture or ap�liance that meets all three of the following <br /> requirements: <br /> i. Does not require modificarion 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 plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit � $ 15.00 <br /> State Surcharge $ 1.00 <br /> • Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />