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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 Floor Drains <br /> Lavatory Sewer Ejectar � <br /> Bathtub Laundry Tray ! <br /> • I <br /> Shower Washer I <br /> Kitchen Sink Water Heater I 'i <br /> Disposal Water Softener ' <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous I <br /> ❑ Yes,this section applies II <br /> The replacement of a Residenrial fixture or agpliance that meets all three of the following reqi4irements: <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 ttus applies; Cost of Pernut $ ' 15.00 <br /> State Surchaxge $ , .50 <br /> Mail-In Fee(If Applicable) $ � 2.00 <br /> Total Permit Fee $� <br /> (Permit Fees Continued On Negt Page) , <br /> 2 <br />