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;'� � � ,� . �� ., � ^�. �_ <br /> f„ �+*� s » -%� � . �..:�b�'�i�...-�, ,,.��. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � I C� Floor Drains <br /> o( <br /> Lavatory ! � � Sewer Ejector <br /> � <br /> Bathtub � Laundry Tray <br /> Shower � Washer � <br /> Kitchen Sink I Water Heater I <br /> ) <br /> Disposal � Water Softener <br /> Dishwasher 1 Wet Bar <br /> l <br /> Sillcocks � Miscellaneous <br /> _ , . . ,, � <br /> y� " � ry��$ <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;excludins 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 $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Negt Page) <br /> 2 <br />