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. <br /> � , . ,� �, .... ti m, . �� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 3 � Floor Drains � <br /> Lavatory � 3 Sewer Ejector <br /> Bathtub � Laundry Tray � � <br /> Shower � 1 Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher r Wet Bar � <br /> Sillcocks Miscellaneous <br /> � Gqra ar ', 1 <br /> S-�e 0.*r� Ll�n�-�- � <br /> -�v1^� `IOWCN <br /> ❑ Yes,this secrion applies <br /> The replacement of a Residential fixture or apnliance that meets all three of the following requirements: <br /> 1. Does not require modificarion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner ar licensed contractor. <br /> Skip next section,if this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Negt Page) <br /> 2 <br />