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i <br /> li <br /> FIXTURE BSMT 1 2ND OTHER FIXTURE BSMT 1 2 ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains ` <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tra I <br /> Shower I Washer <br /> Kitchen Sink I Water Heate <br /> Disposal Water Softener <br /> Dishwasher I Wet Bar <br /> Sillcocks Miscellaneoi is <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance thatm ets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas serye. <br /> 2. Has a total cost of$500.00 or less;excludine the cost If the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner old licensed plumbing contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 1 <br /> i <br /> i <br /> u <br />