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� <br /> ' ` �;?<'°'.PI:fiJMB�I�� .,�'���R�S�"�E�':Ct ij.STAL•��Y1 <br /> FIXTURE BSMT 1 2 OTWER FIXTURE BSN1T 1 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejecto� <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater � <br /> Disposal Water SoRener <br /> Dishwasher Wet Bar <br /> 5illcocks Miscellaneous <br /> � �` i �*�����Idll�a�A'",LTiy �� �� �L'I}n�4�J��`���Ol`1�47� �',,y � s-.. ' <br /> ::�BA"S�D+0 . ,�-�"L002,'�STA��;S�TATUE �� � � <br /> � Yes.this section applies <br /> The replacement of only one Residentia!fixture or appliance that meets all three of the following <br /> requirements: <br /> I. Does not require rnodification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludina the cost of the fi�ture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next scction,if this applies; Cost of Pern�it $ I5.00 <br /> State 5urcharge $ S.QO <br /> Mail-InFee(IfApplicable) $ ?.00 <br /> Total Permit Fee S ��� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />