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,,4!�—.4 t. C i r e a: ,4') <br /> FIXTURE BSMT ls' 2ND OTHER FIXTURE BSMT ls2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet / Floor Drains / <br /> Lavatory / s Sewer Ejector <br /> Bathtub Laundry Tray �y <br /> Shower i Washer / / <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener /✓ <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous r/ <br /> n a Cs er y <br /> r <br /> e m r s <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 />