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i� , <br /> s <br /> J <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2' OTHER <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 I ! <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � <br /> � <br /> ❑ Yes,this section applies ' <br /> i <br /> The replacement of a Residential fixture or a� liance that meets all three of the following reqilirements: <br /> 1. Does not require modification to electrical or gas service. ' <br /> 2. Has a total cost of$500.00 or less; excludinP 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 Pernut $ 15.00 <br /> State Surcharge $ � .50 <br /> Mail-In Fee(If Applicable) $ I 2.00 <br /> Total Permit Fee $�° <br /> (Permit Fees Continued On Negt Page) <br /> 2 <br />