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� 1 <br /> FIXTURE BSMT ls' 2ND OTHER FIXTURE BSMT ls, 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory -Sewcr Ejcctor <br /> Aathttt Laundry-may <br /> .84tewer <br /> R"ITChen Sink Water Heater <br /> W ner <br /> Dishwasher 1 Wct Dai <br /> c ' — 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 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: anti <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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees.Continued On Next Page) , <br /> 2 <br />