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b <br /> oil <br /> FIXTURE BSMT 1 2 <br /> TYPE OTHER FIXTURE BSMT 1 2 OTHER <br /> FL FL TYPE FL FL <br /> Water Closet <br /> Floor Drains ` <br /> Lavatory Sewer Ejector It <br /> 2 <br /> Bathroom Laundry Tray <br /> I <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> I _ � <br /> Disposal Water Softener _ <br /> I <br /> Dishwasher j Wet Bar <br /> Sillcocks <br /> Miscellaneous <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 jmodification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excl 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 <br /> State Surcharge 15.00 <br /> Mail-In Fee(If Applicable) $ 1 0 <br /> Total Permit Fee $-� <br /> (Permit Fees Continued On ext Page) <br /> 2 <br /> i <br />