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{ r;: <br /> S ��' �rt ?�6 � ;'�. <br /> :,-�: � �Af'.5•`�t' F . <br /> t..� <br /> FIXTURE BSMT l 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE <br /> FL FL <br /> Water Closet Floor Drains <br /> � <br /> Lavatory ' ^ Sewer Ejector <br /> L <br /> Bathroom , Laundry Tray <br /> Shower ', <br /> � Washer <br /> Kitchen Sink Water Heater <br /> Disposal ' <br /> , , Water Softener <br /> Dishwasher <br /> Wet Bar <br /> Sillcocks '� Miscellaneous <br /> g^i�,tSt 1�..,� i S �3)s��t ti_, t^ � .� <br /> l.'t ,,{� ` I�i i�b u t �� ; �'t' <br /> t r :. I Cs �� �' t � ��� �� � _ ���`�'S�� U <br /> � r "+1: hY x � <br /> --- tj ���4J�A+/'��_��i'�'«..�_ �� r { � '�rd 1 �.�l�i, <br /> �x.W�n�.e� �N <br /> ❑ Yes,this section appljies <br /> The replacement of a Residentiia[fixture or apptiance that meets all three of the following requirements: <br /> 1. Does not rec�uire imodification to electrical or gas service. <br /> 2. Has a total cost o;f$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved, installed or reY!a�ed�y thz,",o;�►eowner or iicensed contractor. <br /> Skip next section; if this applies; Cost of Permit <br /> $ 15.00 <br /> i State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> TotAI Permit Fee $ <br /> � <br /> (Permit Fees Continued On l�ext Page) <br /> 2 <br />