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, <br /> , P , . Ii'�TG�TC��B��:Ii'�fii� '�',�T�sL�3. -:.. . <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI�R <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 /> ���r;��:�:�.Ct�..�.�Q�v(s� <br /> ^ .B.�'SED Q�F 2�02 S'FA'I`E ST�Tf3� , . — <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or apoliance 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�r less;excluding 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 $ s.pp <br /> Mail-In Fee(If Applicable) � <br /> Total Permit Fee <br /> (Permit Fees Continned On Next Page) <br /> 2. <br />