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R'Psn, S �_' . <br /> x� ., . .. , .. o u <br /> av � <br /> �'��T,�E " . r, . ,�. . " _ - _., �. <br /> , E,.�.„ . . ..,.. <br /> _ � .�. , . ..,� <br /> . . , . $ ; r �'�S <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 Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <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 requue 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 $ .SQ <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $�b <br /> (Permit Fees Continued On Nezt Page) <br /> 2 <br />