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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 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 Bar <br /> Sillcocks Miscellaneous <br /> � � <br /> f S r N � in (� � ^� L,e � �e � � � d G�'Gr� � �� e�. <br /> � �" � �� �f�#v�� �� �� � ,� ;°'���� , � � <br /> �.��,� , , ��a �� ��. ����3 �� � r- ��,3�������� �` �, �5�;�. <br /> �� y �......��.��'�'���',��.a4 �����':�'. , �4'��.. , , ...,.' ,. : ,.::.,a � .�..e. .>.�,��< ;,,`?�i�Y,�K��"„-�1.�R�� S` �. <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or a�pliance that meets all three of the following <br /> 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 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 />