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. � <br /> FIXTURE BSMT 1 2 OT'f�R FIXTURE BSMT 1 2 R <br /> TYPEi FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavato Sewer Ejector <br /> Bathtu � Laundry Tray <br /> Shower � Washer / <br /> / <br /> Kitchen Sink ` Water Heater <br /> I <br /> Dispos 1 I Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks Miscellaneous <br />� F. � <br /> ❑ Yes,this section applies <br /> The rep�acement of only one Residential fixture or appliance that meets all three of the following <br /> require�nents: <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 plumbing conhactor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit�ees Continued On Next Page) <br /> j 2 <br />