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N- <br /> 1 ' <br /> , <br /> 1 <br /> .....,- <br /> FIXTURE <br /> BSMT ' :: ' 2ND C:7::E'R ' TYPE FL <br /> ' '' 13 S'M- T ;I ,I., <br /> I ND OTHER <br /> TYPE FL FL <br /> Water Closet / <br /> Laundry <br /> elaowlerdir:)Ejector <br /> Bathtub <br /> I <br /> Lavatory crtaoyr <br /> Bathtub <br /> Shower / Washer <br /> Water Heater <br /> Kitchen Sink <br /> Disposal Water Softener <br /> ( <br /> Dishwasher Wet Bar( <br /> Sillcocks Miscellaneous <br /> ,Th ...:..;.: ..7' i'. <br /> _ <br /> t . <br /> 0 Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meetssearillithrce.ee of the following requirements: <br /> 1. Does not require eofm$o5d0ifi0.c0a0tioorn lteosse;leecxtricl'ucdalinogr gas <br /> 2. Has a total co nsfiexdturceonotrraacptporli.ance: and <br /> 3. Is improved, installed or replaced by the homeownerto.etrflthicee <br /> Cost of Permit <br /> State Surcharge Applicable) $ <br /> Skip next section,if this applies; s$ 125...050000 <br /> $ <br /> MTotalail <br /> Mail-In <br /> IPh Permit(If <br /> fFe <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />