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.. `� ` <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet p Floor Drains <br /> t <br /> Lavatory � Sewer Ejector <br /> i <br /> Bathtub Laundry Tray ) <br /> J <br /> Shower � Washer <br /> Kitchen Sink d Water Heater <br /> { <br /> Disposal � Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or anvliance 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 secrion,if this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />