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. � . � � <br /> __� � <br /> , , ,.. ; � .,. � Y�������' . <br /> '. �.: „ �, . . <br /> , <br /> ����. <br /> � . ..._.. _._.; . ,` ..:... .,,g..... . <br /> IXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> �'YPE FL FL �2� TYPE FL F ,��v <br /> ater Closet � Floor Drains <br /> avatory � Sewer Ejector ' <br /> Bathtub � Laundry Tray <br /> �hower � Washer � <br /> Kitchen Sink r Water Heater <br /> isposal Water Softener <br /> � <br /> ishwasher � Wet Bar <br /> �illcocks Miscellaneous <br /> �. � � �� � ���£�� <br /> ��. ���� ��"°� � w� ����� ���",�,�� <br /> �] Yes,this section applies <br /> �'he replacement of only one Residential fixture or appliance that meets all three of the foflowi ig <br /> requirements: <br /> I 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: nd <br /> 3. Is improved,instatled or replaced by the homeowner or licensed plumbing contra tor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-1n Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ _ <br /> (�Permit Fees Continued On Next Page) <br /> 2 <br />