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, � <br /> .+ <br /> � <br /> rr;��G��ru�<s=$�r����sr�:�� . ,} � ..; `, <br /> r: . <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER � <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains � <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray / <br /> Shower � Washer I <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher � Wet Baz <br /> Sillcocks � Miscellaneous <br /> # f f <br /> �.�. r ���, 2 �,i�:�� � ���� � .s 2 � x.:'�y� ``-�,� � �'':: <br /> �,.� r�+ <br /> � �fl r ; n� r �;w t. ��}`i�S�i a ,�'� ��=� _� n �f * � �x �a �' <br /> ' � =� L'il'7 � v s j X'"'�4 F =,+;�„ � s <br /> f.� _�S <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;excludin¢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 />