Laserfiche WebLink
� i <br /> ... � <br /> ..�, � . � � <br /> ��. ��� .� ���� _.. . .,� ..,r. . <br /> ..� � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet , z z Floor Drains � <br /> Lavatory ' � 2 Sewer Ejector <br /> ✓ <br /> Bathtub , ' Laundry Tray � � <br /> Shower ' f ' Washer � ' <br /> ! <br /> Kitchen Sink 1 Water Heater � <br /> Disposal t I Water Softener ' <br /> 1 <br /> Dishwasher � Wet Bar , <br /> Sillcocks � Miscella� n�o� � <br /> ���. <br /> �� �. � ��,� <br /> ❑ Yes,this secrion applies <br /> The replacement of only one Residenrial fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludins 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 Pemut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />