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k. r <br /> FIXTURE BSMT 1 2 ND OTHER FIXTURE BSMT 1 2 ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet n Floor Drains <br /> Lavatory , 3 Sewer Ejector <br /> Bathtub Laundry Tray f <br /> Shower Washer 1 <br /> r <br /> Kitchen Sink Water Heater <br /> Disposal 1 Water Softener <br /> Dishwasher l L Wet Bar r <br /> Sillcocks 'ZI T' Miscellaneous <br /> 3 s. <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;excluding 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 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 />