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, , P�:�UIt{lB�N;G"`��XT'URES,$EIl�C;INS�A�.�E� ` , . ; `�` <br /> 4 ;� �S 3;. .�._ <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � / � Floor Drains / <br /> Lavatory � j �` Sewer Ejector <br /> Bathtub � Laundry Tray <br /> � <br /> Shower �, � Washer � <br /> Kitchen Sink ` Water Heater <br /> Disposal / Water Softener I <br /> Dishwasher � Wet Bar � � <br /> Sillcocks e� Miscellaneous �af <br /> d <br /> (',� ��,,� i �-f�'��. <br /> l� ��,.��/��� <br /> f- ,�,„,�,�,`" <br /> � � PER1�IiT��CA�,CL��Z��� � , t a � <br /> �; � �:� A , krr �� , � ,_ <br /> � <br /> ��, �� w ��� � <br /> , : . <br /> � �� _ s <br /> � ' � � -� � ��. v�� �,"�'`"B��'d� �'�'������1������ �� t � � �`»� � "� . <br /> _ ; > y s � �: �,�, h � .�d z' '� <br /> �� , <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;excludin�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 $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> 7'otal Peraaiit Fee $ <br /> (Permit Fees Continued On Next 1'age) <br /> 2 <br />