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4 <br /> .:> PLI�IVIBING.FIXTT7RES BING`INSTALIED' F, .a> <br /> FIXTURE BSMT 1" 21'1 I) OTHER FIXTURE BSMT l ' 2N1.) OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I Floor Drains <br /> Lavatory I / Sewer Ejector <br /> Bathtub I Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar / <br /> Sillcocks Miscellaneous <br /> ��' ;+ Y ti's t�� 3 } �,{t�.r� 1y��O{It "�p,'� 4 "t.�'#�.s:,+�' .r S SNS'.E �qP. <br /> 1 ^�^' �'k�y„S+** ni 'G,.S +S .L'"�F' S'- M f R aqq�'4r) 4 'x,°' Ar+ �„+C{, <br /> f 4�''� �F '` y Y t +�i i1 F' 1 V `5 .. .! W L; � y d� '� 7 <br /> ti.�.FS�iy� !, 4i d `}'�.+`f'4 4 4 Y i SED O '2OOZKT4+ i <br /> K E <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;excluding 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 /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />