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i <br /> �. � . _...F <br /> _ �... . ,, <br /> . <br /> �� .: <br /> .�,. <br /> �.�., ��,�,.,. � ..� ; � <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 Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater I <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <br /> .;: � =� �- <br /> .. .. . <br /> � - - t•. � <br /> � ..�. _ .. m <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance 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 section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ .50 <br /> Mail-In Fee(IfApplicable) $ 2.00 <br /> Total Permit Fee $�Q <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />