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1 . <br /> FIXTURE BSMT 1 2 O'THER FIXTURE BSMT 1 2 OT'HER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 ( � Floor Drains / <br /> r <br /> Lavatory � r � Sewer Ejector <br /> 1 <br /> Bathroom � / � Laundry Tray / <br /> Shower � Washer � <br /> Kitchen Sink / Water Heater / <br /> Disposal / Water Softener � <br /> Dishwasher / Wet Bar � � <br /> Sillcocks 2 Miscellaneous <br /> �. 1 <br /> � � rp5 <br /> � �i� <br /> . �� <br /> ❑ Yes,this section applies <br /> T'he 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;excludine the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip neact section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />