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From:7634974263 02/04/2015 10:48 #514 P.003/004 <br /> � <br /> ,y n - <br /> �, <br /> FIXTURE BSMT 1 2 OTHER FIXTURE $SMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet j � Floor Drains � � <br /> Lavatory � � Sewer Ejector <br /> Bathtub S Laundry Tray <br /> Shower � � Washer I <br /> Kitchen Sink Water Heater � <br /> Disposal ` Water Softener <br /> Dishwasher r Wet Bar ` <br /> � � <br /> Sillcocks � Miscellaneous � ^ �� <br /> t , <br /> ,�;��:�:. <br /> ,�,�,�� <br /> ��� <br /> ��: <br /> ❑ Yes,this section applies <br /> The replacement of only one Residentiai ftxture or appliance that meets all three of the following <br /> requiremenu: ; <br /> 1. Does not require modification to electricai or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and i; <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this appiies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5•OQ ��`' <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ �: <br /> (Permit Fees Contfnued On Next Page) <br /> �• <br /> �: <br /> �: <br /> 3; <br /> 2 � <br /> �`` <br /> �: <br /> �` <br /> � <br />