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4 :.,,Sj�i t <br /> t t''�� :'.�3 ut�'.�� <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 Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> S •tl`� ; bNf�, t b��T�„r^r�' ��?�� � �T�r� '. � JC'�R,x � <br /> �� .2 .r y' 1 �1�Wy j{j� �y/�j��/� � �,S <br /> ,.)., __.1��_ I � �'��U4' ���1 � 4N�� �`J.SF��� �'�, ,�� `�� ! <br /> kf V <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets ail 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;excludine the cost of the fixture or appliance:and <br /> 3. [s 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 />