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. � <br /> �- " r� . . . . � <br /> ♦ � <br /> , ; ,: . P�.,�nv�������n��.��sT.�,1;;�D � � ., _ . <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 /> . 3": "3 �J �W _ a . ,� ... �.f 'd `.FS.E �'� e�... �. �� vt�L�:Y�. <br /> t�+� s. : . -�a'�.�„ j ... °'�� g.. �, �' y�-��-„�, z fr,�S�.�e�f,� . . <br /> �'ta i r' r:� � ' � �� '+�, .7 r���j�'S°��...�r'�'�' �-s� x� `��s 4^i�. <br /> ���, +,+, ,� � p x �, e' . ,,wr:. � T^� �ik ..�� ��C� r � P7P� a,t...,,�y r� � <br /> 5 i�Z _:'- '��s�w'e t �...;�a� , ,. � �,_ - - �i��.'��'����b?at,fih Ev�rs,*���'� ��.+�*.�.,�'.�,�+6: <br /> . _ <br /> � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance that meets all three of the following requirements: <br /> 1. Does not require modificarion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludins 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 />