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� <br /> � ; � ��., , <br /> r A _ <br /> f P �� �" <br /> ,� �,�,� ,�g''4s <br /> FIXTURE BSM7' ls 2 OTHER FIXTURE BSMT 1` 2 " OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet r Floor Drains <br /> 1 <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 /> �� �� � � n � � <br /> � �� � ��`� ` � � ' � ,�� � �� �� <br /> �*�t` a4 � a �'. � 3� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a� liance 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;excludin�the cost of the fixture or appliance: and <br /> 3. Is improved, installed 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) $ 2.pp <br /> Total Permit Fee $ <br /> {Permit Fees Continued On I�Iext Page) <br /> 2 <br />