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�+ �. <br /> F BSMT 1 2 OTHER FIXTURE BS 1 2 OTI�R <br /> TYPE FL FL ? QO TYPE FL FL ? ICO <br /> J <br /> W ter Closet � Floor Drains <br /> L,a�vatory � Sewer Ejector <br /> Bathtub ( Laundry Tray <br /> S ower ' Washer ' <br /> 'tchen Sink � Water Heater <br /> D sposal ( Water Softener <br /> D shwasher � Wet Bar <br /> Svllcocks Miscellaneous <br /> [k] Yes,this section applies <br /> 'I'he replacement of only one Residential fixture or�ppliance that meets all ee of the follo ng <br /> r�quirements: <br /> 1. Do n require modification to electrical or gas service. <br /> I 2. Has a total cost of$500.00 or less;excludins�the cost of the� e or appliance:and <br /> ' 3. Is improved,installed or replaced by the homeowner or licensed plumbing con ctor. <br /> Skip next section,if this applies; Cost of Permit $ I 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applica le) $ 2.00 <br /> Tota!Permit Fee $ <br /> (�'ermit Fees Con6nued On Neat Page) <br /> 2 <br />