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{ r1 ILi.! r, <br /> FIXTURE BSMT 1" 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ! , Floor Drains <br /> Lavatory ' Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower I f Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> 1 <br /> Dishwasher Wet Bar <br /> Sillcocks ,Z Miscellaneous <br /> ., .u, �"," vxr y T7 1 � b • itl `k s�1P y.r i A <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: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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />