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� " �. <br /> 1 ' <br /> FIXTURE BSMT 1 2 OTf-IER FIXTURE BSMT 1 2 OTF�R <br /> TYPE FL FL TYPE FL FL <br /> _ Water Closet Floor Drains <br /> Lavatory pJ Sewer Ejector <br /> X� ,�r�� <br /> Bathroom Laundry Tray <br /> Shower J �J� Washer <br /> Y� � <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous �( X m 0� v��,Y! <br /> i � <br /> � Wa S-�- �'�P� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fiacture or anuliance 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,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) $ 1.50 <br /> Total Permit Fee $ (� ,� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />