Laserfiche WebLink
�' <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 O'IT�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains <br /> Lavator5' / /,L Sewer Ejector <br /> �/ <br /> Bathtub / ��y'T�' � <br /> shoW� � � w�n� I <br /> Kitchen Sink � W�H� / <br /> Disposal r Water Softener <br /> Dishwasher �y�g� <br /> 5111��� � Miscellaneous <br /> 1 <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixtute or appliance that meets all three of the following <br /> requirements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a total�c �t of$500.00 or less;excludin¢the cost of the fixtiue or appliance:and <br /> 3. Is improved,installed or repla�ed 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 Fce $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />