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FIXTURE BSMT v' OTHER FIXTURE �' OTHER <br /> TYPE TYPEmom <br /> Water Closet � Floor Drains _.■- <br /> Lavatory ■� Sewer Ejector -■- <br /> Bathtub -�■� Laundry Tray -S <br /> Shower -. Washer <br /> Kitchen Sink -■ Water Heater -1111■_ <br /> Disposal -■■� Water Softener -■■� <br /> Dishwasher1111 <br /> ..� Wet Bar MUM <br /> Sillcoeks �.■ Miscellaneous _.■_ <br /> I rl �fi�t {. m, � ^-w^ ry •.r�ri�i E' ' �� F R�ilt�l r 7w1 w rr r..N +ro^w. +.ry <br /> � s <br /> Iv � rl { � f i S ry '! ,1�'^ I � <br /> Yes,this section applies <br /> The replacement of only one le$iential fixture or appliance that meets all three of the following <br /> requirements: <br /> I. 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 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) $ q4 <br /> Total Permit Fee $ Q <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />