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� <br /> . /i <br /> `' :.PLU1V�$INCi FIX'�C:TRES��BEING'INS'�'.�L-LED " <br /> � k :, <br /> ,*4�,-�' �'" r � - <br /> FIXTURE BSMT 1 2 OT�IER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I 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 /> y � ��� '� � � �> ��Y���� � ��/ �c�. j++2 r..�� "+k��� �h�t�f�, <�; �,-'�}�".'g�,,�k�.f'r ,.. � !� ;�, <br /> d �" �.a��J^4' Sd��'`h.'�'�W �`„���I'"''� ��� � ���?"`)ti�� t tx'4 �9�"„F r -x r 'H' <br /> .a r n u ra t- �'x F,�'-, <br /> F��t �.e'dY t d �r�y tq .�" . �k.n e , � � -m ,: ,� �� {'��4. y�� x�ua.i ,��,f�r '� <br /> +,� � ;p,�.�`�-�� = r ,��,, s��.�,x, ' �u� � r�� w '� F .�, <br /> �����:-.x � {:� �:�>�..�,. �����S=EL'�C?�'F°+, QQ�S'�`A'�' ��, ; A��¢'�:F� 5-� � � �,����..�� <br /> .t ��: � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requuements: <br /> 1. Does not require modification 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 contractor. <br /> Skip next section,if this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />