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t , <br /> i <br /> ,,.41E , ? z <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT IST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet j Floor Drains <br /> Lavatory 1 Sewer Ejector <br /> Bathroom / Laundry Tray <br /> Shower Washer <br /> Kitchen Sink 1 Water Heater <br /> Disposal Water Softener <br /> Dishwasher I. Wet Bar <br /> Sillcocks Miscellaneous <br /> ' iti'BILA <br /> ,'d & "`3 �,rcG-.Fsk.� ' ='. <br /> 0 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) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />