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� � <br /> � <br /> FIXTURE B$MT 1 2 OTI�R FIXTURE BSMT 1 2 OTf�R <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 I Water Softener <br /> Dishwasher I Wet Bar <br /> Sillcocks Miscellaneous / _ �c,t �Z,e,� <br /> i e.. <br /> i <br /> i <br /> i <br /> ❑ Yes,this s¢ction applies <br /> The replacement of;a Residential fi�cture or appliance that meets all three of the following requirements: <br /> 1. �Does�ot require modification to electrical or gas service. <br /> 2. Has a itotal cost of$500.00 or less;excludine the cost of the fixture or appliance: and <br /> 3. Is im roved,installed or replaced by the homeowner or licensed contractor. <br /> Skip�iext 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 /> � <br /> (Permit Fees Contf nued On Next Page) <br /> i <br /> 2 <br />