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� <br /> ':. �,.�; ����,� :.PLI�IVIBING:FIX'i't�RES��$�ll�TG;INST:�LI,ED� ` <k h ' �; f �; <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 <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener / <br /> l <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneo � <br /> �� , <br /> ��1/as/Z-S� l <br /> L%��'�''�ES <br /> s��" p�.��t�� .. rL��a c�r� H������r�������'I���.:r '����11�����#e�r'f���k,L�4��x�4� ��,F n��`1 r�t'�r C; <br /> � -3� 'V Z `44. �? 4 W i5 .'�+? 1 4l. `'i <br /> sk, ,'L+'„y � _ r�e r r,�,��aG )+'` {..�� '.�* �+e c 'k 3°'�'+r � '� � s.�"�'6.�a� X:_� <br /> )'v� ,�;+��¢e"��& N ��h'Y�"'y�,,< �`a����r�,V '� .�����7����„�`�l�,���,.�* l� � a•,fx� ^��!".�v�.�;�?aw..3.,. <br /> n,...x. • w �:::,.. . c *.�n«, ,.t..,...r.K.,.._ .. .. . . . . .. .... .. ,_ .. . ; <br /> ❑ Yes,tlus 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;excludinQ 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 Pernut $ 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 />