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���:sb ��� �� <br /> t ro ,�„ a i �. <br /> . <br /> �' <br /> ,..u,- ,i-, x_�. �„ r - _� �,, <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater ' <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sil Icocks Miscellaneous <br /> � d �.�, � �a� �" ��� .� , <br /> �� � � � y� � % . <br /> � �� �"�a .r� �� .� � <br /> t. � ��=��° a� <br /> � ,f,�.. <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 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;and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $�� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />