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� <br /> � <br /> . <br /> . , <br /> " _; PLi�MBING.FIXTURES��E�NCr�TNSTA;I%I;ED . °" ' �' <br /> ,�.,<: � �:: " <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 ( W asher I <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 4� 1'�, �.£ .'r'.�{ �W��'" �'.�an"'��.5�.a r ��%*�'�t���,��.�,•�a'v+9b���O�CU,�I�� tP*� 4���'3'9��3' '� _ f Y���f+�'�, <br /> F�-'�� �:c'`S.� -i� 4��s��'y.ia5�"ry�.Y �yd�r¢'p (f'(�!1 � �" r' (�'�`c F}_e k�•r 'i"'� J. d�a� '�' ,�a '�� a <br /> '�.�1. s:� � t �.a.. t S 4.. 'm.ti, (. � „ ' r s �'a A :yv� ,,�:., <br /> » .., ... '" ...,.�i3 .� .,-r..+F�T�i77:I�_.Y� 2��1,i+�7���.����..:4`..�. ... . e ..„q.`; 1 . <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 modificarion to elecriical 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 Pemut $ 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 />