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FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTF�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � 3 Floor Drains � <br /> Lavatory � 5 Sewer Ejector <br /> Bathtub � Laundry Tray 1 <br /> Shower 3 Washer 1 <br /> Kitchen Sink 2 Water Heater � <br /> Disposal � Water Sof�r►er � <br /> Dishwasher � Wet Bar � <br /> Sillcocks 3 Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require mod�cation to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the f'v�hue 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 $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2A0 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />