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, . . � <br />• ; <br /> FDCTURE BSMT 1 2 OTF�R AIX1'IJRE HSMT I OTHER I <br /> TYPE FL FL TYPE FL FL <br /> � WaterCloset � Floorlhaina <br /> I <br /> Is�.ary 3 sewerB;ocrur ; <br /> ; Bathmb � Lawdry Tray / <br /> , Shower Washar <br /> � <br /> Kiuhm�Sink Wuu Hmtar <br /> � <br /> ,' Disposal ' Water Softona <br /> , Dis6wesha WetHar <br /> ; Sillcocks Miscellanaow <br /> I <br /> I <br /> ❑ Yes,this section applias <br /> i <br /> � Tha roplacemmit of only one Residm�tial fixture a aooliancs t}at meafs all tiva of the following I <br /> raqu'vemonts: <br /> : l. gQg}„pys require modification to alactrial or gas smvice. <br /> � 2. Has a��of SS00.00 or less;occludina tha cost of the fvctiue or appliance:and I <br /> � 3. Is imprrned,iretalled or replacal by ihe homaowna or liwnsed plumbing coatractor. <br /> Skip noct seaion,if this applies; Cost of Permit S 15.W <br /> Stata Surcharga S 00 <br /> � Mail•in Fos(If Appticable) S 2.00 <br /> ' Total Permit Fee S <br /> (Pe�mit Fea Cootinned Ou N�t Paee) I <br /> 2 � <br /> � <br /> � <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br />