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PI;UMBINGFIXTUR�S B'EINGr',INSTALLED ` ` <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> �ypg FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> , <br /> : : . <br /> : PE�IT FF�E G P�.,CTJLA.T�ON(S) <br /> ' . B.A�FT� �F� -200� STA�'E`S'I'AT�.TE �' <br /> ❑ Yes, this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requuements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. I�as 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 $ 15.04 <br /> State Surcharge � .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> '�'otal�ermit�'ee � <br /> (�ermit�ees Continued On Next Page) <br /> � <br />