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, <br /> . <br /> � �� � �, <br /> .� <br /> , , „ . :t,a.. ,, k�4rt� � �: . . _w.:; . . : F . ,.. �wr. � n <br /> , <br /> r , � �a <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 Floor Drains <br /> Lavatory j Sewer Ejector <br /> � <br /> Bathrtaex�n',:-t Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater ' <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ` '��i��� � , u ���LG�TJ�:AT�;�' �'�° , J <br /> � a�i�4� �,.�,�. �. � �1�r�+�".`'��'A�j ' �,r�,r��, <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance 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. ls 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 />