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ti <br /> � <br /> t� � � ��".. � ��k���, ,_.� � � � � -�:. <br /> �.. . <br /> . <br /> �.: � � � � a <br /> . <br /> >��,� ��,,��� � . w, ,ti ��` ° .;�h.. � ���x <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 I Water Heater ( <br /> Disposal r Water Softener <br /> � <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> �� _�� . � � - , .-�, ��. . h-.. �� .n. -"'`+ <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electricat 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 $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />