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, � <br /> ;h �_ <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 /> .�� Laundry Tray <br /> t3.,��.� <br /> Shower � Washer <br /> Kitchen Sink Water Heater <br /> Disposal VVzter Softerer <br /> Dishwasher Wet Bar � <br /> Sillcocks Miscellaneous <br /> � __.._�_., _._ ___ _ _________ __ . _ ,_ <br /> 1'T��RMIT'�FGF, C�,LCl.1L,A'1'TON f5) '����` ��� <br /> �3ASED UT�'!� =200? STATE S"I,AT[1L <br /> : ,_ �: _ _� _-_ _ ___-_--_. __ _._ __:_ . _._ ._� <br /> ❑ Yes,this section applies <br /> �� <br /> The replacement of a Residential fixture or liance that meets a three of the following requirements: <br /> l. Does not require modification to elec 'cal or ga�'service. <br /> 2. Has a total cost of$500.00 or less;exclu in the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the h eowner or licensed contractor. <br /> Skip next section, if this applies; Cost o Permit $ 15.00 <br /> State Su harge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />