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From%enz-Ryan 952 767 1900 07/11/2012 08:44 #212 P.007/010 <br /> FIXTURE BSMT 13T 2 OTHER FIXTURE BSMT I 2mu OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains i <br /> Lavatory Sewer Ejector <br /> Bathtub ` Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink Water Heater t <br /> Disposal I Water Softener <br /> Dishwasher j Wet Bar <br /> Sillcocks I Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Hasa 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />