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' , . <br /> PLIJM�3Il�1�.�T�'�;7R;�S'B��N�''r�2TI�'�'$A�:.L�� : -_ .: <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 <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � PE�N1�T��CA�.C��TIQ1�7�S��� n� ����� � ��"�.� �, <br /> BASED-O�'F`=20�2`ST,�,.TE.��i'T`C���. ��.�.�: �:��`... �.F< ° `�. "<. <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 /> l. 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 plumbing contractor. <br /> Sl:ip 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 />