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��.��B�t����:3R:����� . ,�.'�.�,�-. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 2 2 Floor Drains <br /> Lavatory 1 3 4 Sewer Ejector <br /> Bathroom 1 2 2 Laundry Tray <br /> Shower 1 � 2 Washer 1 <br /> Kitchen Sink 1 2 Water Heater 1 <br /> Disposal 1 Water Softener <br /> Dishwasher 2 Wet Bar <br /> Sillcocks 2 Miscellaneous <br /> ,� � �� � ° � „ ��� <br /> �.;� x � � p �-. � �� <br /> � �..,.a � <br /> .,_�. <br /> . . . ,. <..- : .'..�'�. . ` ����. �� � . �� ' . -: �x .F���- Z <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or apaliance that meets all three of the following requvements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip ne�ct section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />