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� <br /> � <br /> :: ,�,'-�_:: � : .: . .:PLL�BING FIXT�RES�B�I.NG:INSTAI;I;EL?'�, � �._ : F, .�i ='' <br /> pIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 3 2 Floor Drains � <br /> Lavatory Sewer Bjector <br /> B athtub � � Laundry Tray � <br /> Shower � � Washer � � <br /> Kitchen Sink ' Water Heater C <br /> Disposal ' � Water Softener <br /> Dishwasher ' r Wet Bar <br /> 1 <br /> Sillcocks � Miscellaneous <br /> �f� ��'xn F^' u '*�.�yq�Y` �k�,�:�aFt �� +�'���,u�i� .�� ��0������ ��;�5��r�������� �/� f` � ?'�..t� 4���� <br /> F�6� 3ri„ �^iY,f`N" ds'�p'" Ay73�:.t q .�'�c4.f4" j k n;y ¢ x � �.�� a u hAa � A4,N..s Y�F i^ 5 �'� . ��� ��:'�r �' 4 �. i� , <br /> .t+'c A,�>i�"� C �, ^�t,,�t,� 4 3 w�� � . �� ���r�r c A �t ,�n,.� .+yS� y °��:6 pL�F,' '��'� `"� � <br /> ; ��� � .�s�,,:`.a�,.��.`���� ,."'�`�����,Q�, .�Q,u�+a�.Ci'��'�161,���.'�,,'. � '�.-�,s;a-��M,: ,�;;.: <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or�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;excludine 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 /> Tota!Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />