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, <br /> PLL'�&�£�FIXTLJ1tES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTF�R FIXT[JRE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet i Floor Drains <br /> Lavatory 1 Sewer Ejector <br /> Bathreem-f tab � Laundry Tray <br /> 1 <br /> Shower 1 Washer <br /> Kitchen Sink 1 Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks 1 Miscellaneous <br /> �����`��`���.E�:���. <br /> . ��������.����� ' • '; , <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fi�cture or appliance that meets all three of the following requirements: <br /> 1. Does no require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fi�ure 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 /> Totsl Permit Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />