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f <br /> - ,. - � <br /> i � <br /> � <br /> � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL �L <br /> Water Closet Floor Drains I! <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray I <br /> Shower Washer i <br /> Kitchen Sink Water Heater I ' <br /> Disposal Water Softener i <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous ! <br /> ii <br /> ❑ Yes,this section applies ��, <br /> The replacement of a Residenrial fixture or appliance that meets all three of the following req�irements: <br /> 1. Does not require modification to electrical or gas service. I <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance I and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. � <br /> Skip next section,if ttus applies; Cost of Perxnit $ I 15.00 <br /> State Surcharge $ I .50 <br /> Mail-In Fee(If Applicable) $ I 2.00 <br /> Total Permit Fee $� <br /> Permit Fees Continued On Negt Pa e II <br /> � g ) <br /> 2 <br />