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� <br /> � � � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet i Z 2 Floor Drains 2 Z 2 <br /> Lavatory ' 3 � Sewer Ejector <br /> Bathroom Laundry Tray <br /> �'c.n���a l ( <br /> Shower Washer <br /> Kitchen Sink ( Water Heater � <br /> Disposal Water Softener � <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <br /> UQtNh� ;y�' . I <br /> ' pD � � <br /> Ro�6 t�k 1,►.� a►s�y 2 t�i,o�.�_ ��c�S <br /> ";� ,� <br /> i��h,'�,, ; <br /> ,. ;, <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(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />