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L _ .., s i'' m,,I `�a , '�. - °�,-O*Ck�, <br /> � B t_�,. W�Gi*8e ��Hm d,q. t m <br /> FIXTURE BSMT 1 s r 2ND OTHER FIXTURE BSMT l s r 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 31;24, Floor Drains <br /> Lavatory 3 zt-A Sewer Ejector <br /> Bathtub ( 3+e-t Laundry Tray <br /> Shower t 3 ck.b Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> v4//./r-- wa%w26 A)C 3.14 eq -44 -TY S1 <br /> P'p/42 C z>07/3 2)A ,4/3 A <br /> nz S ;# -`r-�, e -41;�x s <br /> ° <br /> � "` 7.7:1 <br /> „e' <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> 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 plumbing contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />