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� <br /> PLUI��NN�i`r� . , '����`i�.��3 . <br /> FIXTURE BSMT 1 2 OTf�R FIXTURE BSMT 1 2 OTf�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous 1 <br /> �a�ut�rK$r�,�,�r' <br /> � E <br /> s:� ..�.;. �'� �., � ����'; <br /> ❑ Yes,this secrion applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Dces 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 this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />