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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 /> _ G :r ��C �D/¢• /3a� i/a�-- =ny'�i���/'iGC�J'�i;�-�-. <br /> r ,� �� <br /> v7-� GA✓ si%.� ,Si,s'/��G( /��il'6�r� cvr.�/��s+ G„o�,,�-��.-x�:,-, �'szC. <br /> !' <br /> - l'G�a;r�rc��ccc,. � �1� con1�Z�,C� G�(. <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture ar anpliance 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;excludine 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 />