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� <br /> . � <br /> n, ,,, <br /> , <br /> . �� ��� � �.��, ,: , <br /> �n� �,� <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 Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Siilcocks Miscellaneous <br /> _�'��� � ;, � � <br /> � <br /> ������ � <br /> _.. . < . _ <br /> ����,� �+,, <br /> � Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets atl three of the following <br /> requirements: <br /> l. 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 /> Mai(-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ ZO'�� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />