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I . . <br /> i , <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 Z OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains ! <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray , <br /> . � <br /> Shower Washer , <br /> Kitchen Sink Water Heater I ' <br /> Disposal Water Softener <br /> i <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous I <br /> ❑ Yes,this section applies II <br /> The replacement of a Residential fixture or anpliance that meets all three of the following requ4irements: <br /> 1. Does not require modification to electrical or gas service. I <br /> 2. Has a total cost of$500.00 or less;excludinQ 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 this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ I 2.� <br /> Total Permit Fee $ i7 0 <br /> t <br /> (Permit Fees Continued On Next Page) ' <br /> 2 I <br />