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r <br /> . <br /> .-� t <br /> +,- . <br /> �`�`' ..�,�`'Y���.rec .�.-.�s�.;#�"i'- � 4,s',���+T'lk����`�c�.. _ '"'�.�� ��"'3 ��!����*�'��x���-: <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 � � Floor Drains <br /> d <br /> Lavatory °� Sewer Ejector <br /> Bathtub � 3 La.undry Tray <br /> Shower ` Washer M <br /> � 1 <br /> Kitchen Sink � � Water Heater I <br /> Disposal ( Water Softener <br /> Dishwasher I Wet Bar <br /> Sillcocks �� Miscellaneous <br /> y,� ,� <br /> n . �' = x yl .: P . . .. t �_ ����� � J'� � �s, �. <br /> r a ` s. � �='�.'.e'Y>�'3..'r`r 4 Y �'`' -�r k�' _ F � �'�j. '�'�`' <br /> �4�:� ': - � �.� w r T `r .�i�-�. q- u��...� ��'�''t�a: p .��'��.S,pr�'v. <br /> s :ti .,.a� '.�s. � r �:�. a+' ��.._�- <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;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 Pemut $ 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 />