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1 <br /> , ` � <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet t I � Floor Drains � <br /> 1 <br /> Lavatory + 1 , ` Sewer Ejector <br /> 1 1 '"� <br /> ���� 1 � Laundry Tray ,t <br /> Shower � Washer 1 <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher � , Wet Bar � 1 <br /> Sillcocks n Miscellaneous <br /> ex <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or annliance 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 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 />