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� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory I Sewer Ejector <br /> Bathroom Laundry Tray � <br /> Shower W asher <br /> Kitchen Sink � Water Heater ' <br /> �. <br /> Disposal Water Softener <br /> Dishwasher I Wet Bar <br /> Sillcocks Miscellaneous � '� ��-� ��lc�_ z (�� ,_,, <br /> � �r� �jc� <br /> I'I.:IZMI I' �'1��;CtiI.,CUL;A"[,ION(S) , <br /> I3,�1S�'D ()Ia'�' —200? Srl,r'17'E ST��TtTE <br /> ❑ Yes,this section applies <br /> � <br /> The replacement of a Residential fixture or appti�nce that meets all three of the following requirements: <br /> 1. Does not require modification to electri�al or gas s �ce. <br /> 2. Has a total cost of$500.00 or less;exclu 'n th ost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the hol�bwner or licensed contractor. <br /> \ <br /> Skip next section, if this applies; Cost o ermit $ 15.00 <br /> State Surc rge $ .50 <br /> / Mail-In Fee f Applicable) $ 1.50 <br /> �/ y Total Permit e $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />