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. . � ����'�' - ��. <br /> ��Z,1�T�C���TU:��. __ �... �� <br /> F[XT RE BSMT 1 2 OTHER FIXTURE BSMT 1 2 THER <br /> TYPEI FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatc�ry Sewer Ejector <br /> Bathtu f Laundry Tray <br /> Showa�- � Washer <br /> Kitchen Sink / Water Heater <br /> Dispos I Water Softener <br /> / <br /> Dishw her / Wet Bar <br /> Sillcoc s Miscellaneous <br /> � ; <. <br /> ' 1��.�`.�1I.�.���C��{�� :� <br /> �ER,.�'���+��� <br /> °BA��.S1����' �4��.�`�'A'1�����"IIE � � <br /> ❑ I 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 /> I 1. Does not require modification to electrical or gas service. <br /> I 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> I 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> ! State Surcharge $ 5.00 <br /> Mail-In Fee(If Appticable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permitl Fees Continued On Next Page) <br /> I 2 <br />