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II <br /> 1 <br /> .;. PLumBtsG FixT RES.43EING'INSTALLE'n. ,,it <br /> FIXTURE BSMT 1" 2m) OTHER FIXTURE BSMT 1" 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Close '3 <br /> t Floor Drains <br /> Lavatory 5 c C- Sewer Ejector <br /> BathtubI 3 Laundry Tray <br /> Shower <br /> I Washer <br /> Kitchen Sink 1 Water Heater I <br /> Disposal t Water Softener I <br /> Dishwasher L Wet Bar <br /> Sillcocks 3 Miscellaneous <br /> r^+n -i st 4.?7_ <br /> � <br /> i es - � t 'fi r � tr �� 7Y , � � r , t :k -. ��..� ki� � r�d �'�n ,� 0O 2S � ' E,- V; :. ,A. v., .' <br /> � � . .„ � ..sAPASE ? .2EA : , <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 />