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�_ '. <br /> . <br /> � <br /> � ��" 4 y �� � � ; <br /> �� ��.�. �� �:. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE <br /> FL FL <br /> Water Closet Ploor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower <br /> Washer <br /> Kitchen Sink �Vater Heater <br /> Disposal <br /> Water Softener <br /> Dishwasher Wet Bar <br /> Sil lcocks Miscellaneous <br /> ' u �-w"��.1��,.� � � �;,. '� t} a$t �g •�,�> <br /> :�i��#�': ^:a��s �-�.r`t��, � �... ...��� .�.��,}�„�'x• <br /> � Yes,this section applies <br /> The replacement of only one Residential fixture or a� liance that meets all three of the following <br /> 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 plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ 2 Z•0� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />