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_ <br /> 'n .� � '" f '�� �,+ � a,�����s',C���?�,•,���-rV".�,J.L�la7����� ��er� �` =J ��3 `��;�+ew. <br /> r <br /> �"t '��e-' ��p.e, ,a4� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> .-_,., . . , _ <br /> Lavatory � Sewer Ejector <br /> Bathtub i1 Laundry Tray <br /> .L <br /> Shower if Washer <br /> �L <br /> Kitchen Sink � Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar � <br /> Sillcocks Miscellaneous ,..,�Q <br /> ' '� �.�rn"�'; ` i �i ��'µE��'r� '''���,� <br /> � � �# a�� � '"��„ �e�d�# � , � . <br /> ,�ilr r ,� ' � � � �, � ��, �5��� },k��� �.$�k���» <br /> ."�n4Zr #�i^�.�^`dr k�. a., x��.�S��;V�", aip; � �.,��ck'- �'�,.t��. '�„"� 3'� +�".� <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 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 />