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r <br /> ' �l'�J`� � ��"�,��.A:�4��a,,=—�a,�=^M���'.�� } �� ;'', :. i, " <br /> FIXTURE BSMT 1 2 OTI�R 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 1 Washer <br /> � <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <br /> TCe i�'�c�,�H� <br /> � � .�ti�;� # � ,. � � � , ��,w <br /> ,� �` � .�� � �� y� �` � � � � _ <br /> .. . _ . � a <br /> w , .-w � T , � <br /> " "� w,� ,, ` .. �L.��.�, < < ,,� i�nu,�u; . r ':.. <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;excludinQ 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 $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />