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, � <br /> . , <br /> ,� <br /> • . <br /> . PL'L��i�C�3�'i'U�:�3��1,- :T�T � ` " �. '�� � <br /> rirt� � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> .I.ypE FI, FI, TypE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray r <br /> Shower Washer <br /> Kitchen Sink j Water Heater <br /> Disposal Water Softener <br /> Dishwasher � Wet Baz <br /> Sillcocks Miscellaneous <br /> Y Y '. � y� P .f� . ,. + �� �a y� .�,\ <br /> .. 't'° '' .1 {` �,}} .- � t Tt� � � t 9E." } � �.y_'fk,� <br /> �� ���sri��„ ^>'rt* �,,•°�'v �r ,:�% f:4�j �' � � <br /> � ��['� <br /> �,;G <br /> .6 a '4'�:. � ' '' rZ .b. +4'",��. <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential 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;excluding 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 $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />