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. i <br /> '� II�. ��� .,�i..,�,aa'� Tt n.,t��. .'. <br /> � <br /> F XTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI-IER <br /> E FL FL TYPE FL FL <br /> er Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Ba�thtub Laundry Tray <br /> Sh wer Washer <br /> Ki chen Sink n Water Heater <br /> d <br /> Di�posal I Water Softener II <br /> Di�hwasher � Wet Bar <br /> Sill ocks Miscellaneous <br /> I <br /> I <br /> � *r_. ,.�� ._�� <br /> �;�;, <br /> ❑ I Yes,this section applies I <br /> The teplacement of only one Residential fixture or annliance that meets all three of the following I <br /> requ�rements: I <br /> 1. Does not require modification to electrical or gas service. �I <br /> I2. Has a total cost of$500.00 or less;excludine the cost of tlie fixture or appliance:and I <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractar. <br /> Skip next section,if this applies; Cost of Permit $ 15. <br /> I State Surcharge $ 5.0 <br /> Mail-In Fee(If Applicable) $ <br /> Total Permit Fee $� <br /> (Pern�it Fees Continued On Negt Page) <br /> � <br /> 2 I <br /> �I <br />