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a <br /> FIXTURE BSMT 1 2 OTT�R FIXTURE BSMT 1 2 OTT-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ��ar� Co� ����c � -- c..��9 ��c�� — �o c�r�c'�� <br /> ( �, . � � <br /> Q�u�-.� i�� � �J�.1�'�i�� ��� � �-��, S l /�.'c ' l a��o,"'� r <br /> Q � <br /> � � �i �4�� i�S �C� � �r�!'t ��� �y9 0 �4� l� � O/L� <br /> � <br /> ❑ 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;excludine 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 />