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I <br /> i <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> i TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> i <br /> Lavatory I I Sewer Ejector <br /> i 1 <br /> Bathtub ' Laundry Tray <br /> I I <br /> Shower Washer <br /> Kitchen Sink Water Heater I <br /> Disposal Water Softener <br /> I <br /> i Dishwasher Wet Bar <br /> i <br /> Sillcocks Miscellaneous <br /> i <br /> i <br /> i <br /> i <br /> I <br /> i <br /> Yes,tbls Section applies <br /> The replaccment of only one RrAidential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. DDQcs require modification to electrical or gas service. <br /> 2. Has a total st of$500.00 or less;ZWu_d ng 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 S 15.0Q <br /> State Surchargc $, �4 <br /> Mail-In Fee(If Applicable) S 2.00 <br /> Total Permit Pee $ - <br /> i <br /> (Permit Fees Cwtkaued On Next Page) <br /> i <br />