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FIXTUR� �SMT 1 2 OTHER FIXT'URE BSMT 1 2 OT'�iER <br /> TYPE FL T�'L 'IYpE FI, FL <br /> Water Closet Floor Drsins <br /> Lavatory Sewer Ljector <br /> Badiroom Laundry Tray � <br /> Showec Washer <br /> Kitchen Sink Wacer Heater <br /> Disposal Water SoRener <br /> Dishwssher Wet Bar <br /> Sillcocks , Miscellaneous <br /> ❑ Yes,this section applics <br /> The replacement of a Resjdential fixturc or aooliance that meets all three of the following requirements: <br /> 1. e not require modification to electrical or gas service. <br /> 2. Has a to�of SS�0.00 or less;excludin the cost of the fixture or applience:and <br /> 3. 1s improved,installed or rcplaced by t�e homoowner or lieensed contractor. <br /> Skip noxt scction,if this epplies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee S <br /> (Permit Fees Continued Op Nezt Psge) <br /> . 2 <br /> � �a z��o ��N Wd���z aooz �zz �das <br />