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� � <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OT��R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � •z Floor Drains .Z <br /> J <br /> Lavatory l � ,j Sewer Ejector <br /> _� <br /> Bathroom / Laundry Tray 1 <br /> Shower � / Washer / <br /> Kitchen Sink r Water Heater � <br /> ! <br /> Disposal Water Softener <br /> Dishwasher / Wet Bar / <br /> Sillcocks Miscellaneous <br /> 3 / ��,�c.�� S.4� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following 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,instailed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />