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� <br /> � <br /> r � <br /> _ _, , , . � . <br /> �"� �� ,�� � � , p , � . � - � ,� <br /> ° , <br /> 4, . r_��,t. <br /> � <br /> ..�;.� ��� ��_, ,• �� „ . � , <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet f 1 Floor Drains <br /> Lavatory � � Sewer Ejector <br /> Bathtub ! r Laundry Tray � <br /> Shower Washer <br /> Kitchen Sink � Water Heater <br /> Disposal � Water Softener ` <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> �L/�it� � <br /> �� � � �. <br /> ❑ Yes,this section applies . <br /> The replacement of only one Residential fixture or appliance that meets all three of fhe 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 />