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�- � <br /> � , <br /> � / <br /> J <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 Ejectar <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater ( <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> i <br /> � <br /> ❑ Yes,this section applies I <br /> The replacement of a Residential fixture or appliance that meets all three of the following reqv4irements: <br /> 1. Does not require modificarion to electxical or gas service. � <br /> 2. Has a total cost of$500.00 or less;exciudine 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 Pernrit $ 15.00 <br /> State Surcharge $ I .50 <br /> Mail-In Fee(If Applicable) $ i 2.00 <br /> Total Permit Fee $�° <br /> (Permit Fees Continued On Nezt Page) I <br /> 2 <br />