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. , � <br /> � � �. m,<.. __ ,.� <br /> � � � ;_ �� � � ��:�e �� <br /> _.�,:,, -=�_. � _ ... ._ .. . . <.... �.`. <br /> FIX BSMT 1 2 OTI�R FIXTURE BSMT 1 2 O R <br /> TYPE FL FL TYPE FL FL ' <br /> Water C1 set Floor Drains ' <br /> Lavatory j Sewer Ejector <br /> J <br /> Bathtub Laundry Tray <br /> Shower � Washer <br /> � <br /> Kitchen�ink � Water Heater <br /> Disposal I Water Softener <br /> � <br /> Dishwas er r Wet Bar <br /> Sillcocks Miscellaneous <br /> j <br /> a�� �' "`� ' � � �< `, ��� f <br /> : � . � � <br /> .,, 1 = ..} ° ���� . � � ���" { <br /> . �,w,. , . _- <br /> ❑ Yes,this section applies <br /> The repl�cement of only one Residential fixture or appliance that meets all three of the following <br /> requiremlents: <br /> il. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludina the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />