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t <br /> PL V MBIN T 1%1N 4NS li r , '„ <br /> FIXTURE BSMT 1 2 N11 OTHER FIXTURE BSMT 1 2 No OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener ` <br /> Dishwasher Wet Bar l <br /> Sillcocks Miscellaneous <br /> �E 3� LC & 333 f}i <br /> BASES „„,200 STA`;f <br /> �_.Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> I. 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 $ 1 S.4J <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />