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. � <br /> �; �' r � , ' ����,�� ��� t�'i.�:�B��'����12� �,EINC����`���1 � � e�� 'e ��� °, <br /> r��� � .w�� <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet l � � Floor Drains Z <br /> Lavatory � I 3 Sewer Ejector <br /> Bathtub / � Laundry Tray j r <br /> Shower ! 1 Z Washer � ' <br /> I <br /> Kitchen 5ink � Water Heater <br /> Disposal � Water Softener <br /> Dishwasher I Wet Bar � <br /> Sillcocks � Miscellaneous <br /> L <br /> � 4 , ���� `��' ���'���� r�.�` ! 4 <br /> � +a..._...�.A..� �,.��:��'.�,�......c,� � 3.,a.������ti`����������,���a � ���«k ����� ��-Y ��k'�.� � 9�'`i. <br /> } <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixiure or anpliance 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 ia�roved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Nezt Page) <br /> 2 <br />