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. � r <br /> FIXTURE BSMT 1 2 OTf�R FIXTURE BSMT 1 2 O'TI-�ER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet / � Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower / Washer <br /> Kitchen Sink / Water Heater / <br /> Disposal Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks Miscellaneous <br /> ❑ Yes,this section applies <br /> The reptacement of only one Residenrial fixture or appliance that meets all three of the following <br /> requirements: <br /> i. Dces not require modification to electtical 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 plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Swcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Negt Page) <br /> � <br />