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'7�aw at2� 55� 1..139�� a�F sbzk a4sr dig `s <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ' Floor Drains <br /> Lavatory cQ 4 LI 1 Sewer Ejector <br /> Bathroom / Laundry Tray <br /> Shower / / Washer <br /> Kitchen Sink / / Water Heater tg <br /> Disposal / Water Softener <br /> Dishwasher -W t-Ber <br /> P.►1 <br /> Sillcocks Miscellaneous <br /> I C.e:tYNxlkr`eS <br /> "-r&c�c-L 1', fNe. <br /> C-Oke1 w off.l;ner So v cw <br /> ro <br /> ❑ Yes,this section appli- <br /> The replacement of a Residential fixt - or a.•Hance that meets al three of the following requirements: <br /> 1. Does not require modification electrical or gas.ervice. <br /> 2. Has a total cost of$500.00 or less; •.cludin t cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by t' hom,owner or licensed contractor. <br /> Skip next section, if this applies; C.st • Permit $ 15.00 <br /> :tate Su : arge $ .50 <br /> Mail-In Fee f Applicable) $ 1.50 <br /> Total Permit ' • $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />