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� <br /> t <br /> Y <br /> .PLITII�ING�FIXTURES��EI.N�''r`�TN�TA;L�,'ED'�, , ?, � <br /> _.. <br /> t�- o p�- r� :: ;� Y �%, .: <br /> : 4 , Y`v <br /> '�'$ .I.. Y � ,...,.'' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains ' <br /> t � a <br /> Lavatory Sewer Ejector <br /> ( 1 3 <br /> Bathtub � � Laundry Tray � � <br /> Shower � J Washer J <br /> Kitchen Sink f Water Heater ` <br /> Disposal Water Sofrener <br /> 1 <br /> Dishwasher ' Wet Bar � <br /> Sillcocks a Miscellaneous <br /> �s ��,,�rti ;+ Y� s N �,q'."�� S{,�a e� S �' � z �� r*��t'�^i�°��5r9���F� .r � R�t* �{: <br /> 41i.L A ` y��-+1 � 4.�J±j Y"M'"`yµ�YE/� �i�,������'�1 T�� ��p������,� �� � �..t^ �'�w�.�,'e�'� f 4�. <br /> �g�� ,+� f <br /> 'p /� (�/� TT �� 3 <br /> ��4` �a�M a`�`� �t��'"�,q �*'�*�yFi"3���1:1��.4a� .,,�4lV����� ,�,�'r��t.J��`�'� �y � ,.k t� � #`�.� .✓ c <br /> ?,g4�n�...:..rrr � ..�.:•:�,., C..N-'9�n� .kwr..�,f-sP . . ._� . .� �r.... a..., a� e' ,F:e.r"..� <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 />