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♦ <br /> � <br /> � <br /> . <br /> �,t , 5_ <br /> P�'�TI�` ��'x�I ..�i'�JI�E� �' ';' �''����.���..�'�7 '°� `-� ;�: � �x � �,`" <br /> FIXTURE BSMT 1 Z OTI�R FIXTURE BSATT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink , / Water Heater <br /> i� <br /> Disposal V/ Water Softener <br /> Dishwasher � Wet Baz <br /> Sillcocks Miscellaneous <br /> � ,� �� � �� �'�R:�'��E�,�t�.,�'UL�'���C1�1����.., � �; . <br /> � .� �:� $�.���D�'1�F'-��142�`�'A'�.����'UE . _ � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or apuliance that meets a11 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;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 Permit $ I5.00 <br /> State Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fecs Coatinued On Negt Page) <br /> 2 <br />