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4 <br /> 4 '. <br /> WY 4" ' PISCROMOr�FD URE IEKO.WaUf b . _. V <br /> FIXTURE BSMT 1ST 2N0 OTHER FIXTURE BSMT 1sr 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> reiplaCt (2) 75 jallerYLw404' <br /> 1/\,L41/V-1/4 J IM5 ,) VU <br /> l ctCU_ S't <br /> "� ht, I' F <br /> .2d'�m^�sas" o.'f:&a_.d. s4a'. BX x '". n. � �. 3 <br /> 1.3 Pa rt BASED OFF —2002 STATL, „T'A :` � . � h <br /> qq� <br /> d <br /> 4=,3»ar�rx'� "2� i,� s a�;#�J��aftiv ,a.':s�`t . <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 />