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r <br /> FIXTI7RE BSMT 1 2 OTI-lER FI�{TtJRE BSMI'I' 1 2 OT�iER <br /> TYPE FL FL TYPB FL FL <br /> Water Closet t -� Floor Drains � <br /> l <br /> Lavatory � .�� Sewer Ejector <br /> ���b T.aundry Tray <br /> � <br /> Shower Washer <br /> � <br /> Kitchen Sink t Water Heater <br /> f � <br /> Disposal Water Softener <br /> l <br /> Dishwasher � Wet Bar <br /> Sillcocks � Misceltaneous <br /> � � <br /> 1 <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture�,r,�ppli n�P that meets all three of the following <br /> requirements: <br /> 1, D no reqaire modification to elecirical orgas service. <br /> 2. Has a t�tal cost of$500.00 or less;�cludina the cast of the�xture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing con#ractor. <br /> Skip next section,if this applies; Cost of Pernut $ I 5.00 <br /> State Svrcharge $ S.qp <br /> Mai!-In Fee{Tf Applicable} $ 2,00 <br /> Totai Perarit Fee s <br /> {Permit Fees Continacd On Neat Page) <br /> 2 <br />