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� �� � � x <br /> � ������� �� ���_�����. <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI-IER <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 /> Ce,,,�P�C�re dfA�� I wa��-I vcn� r�QQ�A�B��� ��r�r-• t'ob� '�'o <br /> ��oo� G1¢w� o�' , �R.�.Q\ec��. t.���' \��¢S � � �; It�s� <br /> '�. S;�ks, 1 1a�.��►n� k�.b, 1 serv�ce, S �1�(-• <br /> , � � �����° � ���_ �,� �� � <br /> ; � ��: � � �� � .� � �, � <br /> � 4 ���'��. � ���. ���� �w;��� �� � �'; <br /> a"4ry�...�, � . <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;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 />