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� <br /> � . I <br /> ` ` �. PLUtiI�II*TG FIXTLTR.ES=$EING�STALI,ED � ;'� ' , <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub ' Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �.' �a�:t ti�k ��,4� Fc� 'm''��.�'"�,yx �,'` ,� '������`���� ���ik�����`£ u � � ',€$ � t Y. z �t��`�a` 'u, . <br /> 4x �'a ��'x ���" y�����'" �- a a ��'ap J - � .�'t 3�w� �a�-'9.- <br /> � �b ,t m k" as.��� �€� � nr a �? , � y��, � t�, �» �r� <br /> - * ,.�� <br /> � .�� <br /> �3 ��'a. ..�:�[��w"�'��"M"`` �i �"'�,', a�� �i'l►� _����'V���k' t a.�'.� `q .�s'+'!"s�� =,� ? �,;"4',� ��'a%` <br /> a7 � �+s ,' �. � . ,v.a,. �.- ,��.�''��` <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin¢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 Permit $ 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 />