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� <br /> PLiT11/lBI�N'G�`FIXTLIRES�EING i�TS"T'AL-LED =; - <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet / 2 Floor Drains <br /> Lavatory / � - Sewer Ejector <br /> Bathtub ! Laundry Tray <br /> Shower � Washer j <br /> Kitchen Sink j Water Heater <br /> Disposal � Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> r P�Rl�i1'��E�AL��A�`,�3���s x �. ` �x <br /> `� � � ` � ' .� ;B�SE C�F� �fl����A"�'��'I'�A�. � �� <br /> l� ,_ <br /> , <br /> . <br /> , � , �,.� <br /> � � ! <br /> ❑ Yes,this section applies � <br /> The replacement of a Residential fixture or apgliance that meets all�three of the followmg requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excluding the cost of the fixture or applian�e: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor, <br /> Skip next section,if this applies; Cost of Pernut $ 15.00_ <br /> - State Surcharge $T.50 <br /> Mai1-In Fee(If Applicable) $ 1.50 , <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 _ , <br />