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�= .. �?�;'.. <br /> . .� ����-FI������ �:� � <br /> � .�S�'�3.��D � _ �;.� � �„� <br /> FIXTURE BSMT 1 �4 � <br /> TYPE FL FL ��ER FIXT'UgE BSMT 1 2 OTHER <br /> �E FL FL <br /> Water Closet <br /> Floor Drains <br /> Lavatory <br /> Sewer Ejector <br /> Bathtub <br /> , Laundry Tray <br /> Shower <br /> Washer <br /> Kitchen Sink Water Heater <br /> Disposal I <br /> Water Softener <br /> Dishwasher <br /> Wet Bar <br /> Sillcocks <br /> Miscellaneous <br /> r,��} ,„ <br /> � � �,,� , � y��,, �,� � <br /> :�r x � k# � �"$ <br /> r '�"s e ���„ z� � a i�-� � z <br /> . . . r�p�,� ...,s.�„�'�qYntF� ���``�����"��' �.t> „ �� ���� � . s �� r p��-k'`�$d� „� f cae'��:{{ .y�,�<`n��y��. <br /> •.,„ <br /> � s..a.W � t. �s , < . �; � a 'ar�� �, � '� <br /> . t�..-,n.. .. s.�+���f�� ""'i �.- e� � � 9 �"'�fg� w� � .Y'�'� � '�`�s'��n#� . . . <br /> . . � ...si . . ��-m ."�. .�+ , ... ��'�,s���F�r,����.� "",�.�.� . <br /> � ..,. ,._ .. :,- , <br /> .. � ,. u a,-��. . �__...��"_ .a�;,- k��:'>�-�1,+,� . � . <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a ' liance 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 fiicture 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 <br /> State Surcharge $ 15.00 <br /> _ _..._ $ .50 <br /> _ _- _ _.. .,.,_. _, .__._ _ <br /> _. .�_ . _____ -Mail-In Fae(If-Applicable ___. _ _ <br /> -- <br /> ) $ __ . —1.50 _._ _. ^ ,_ ._ : _ <br /> Tota1 Permit Fee — <br /> $ <br /> -- __--__-_— <br /> ----_--------,._ <br /> ; <br /> (Permit Fees Continued On Next Page) ` ~ --- — <br /> : � <br /> � � <br /> 2 � � <br /> 3 F � <br /> ` �' � <br /> a , <br /> ' . . � . 4 .. .. <br /> _ � � ' � �° <br /> ; <br /> �. , <br />