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�.. <br /> r � � <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet / / z Floor Drains .Z / <br /> Lavatory Sewer Ejector <br /> Bathroom � 1 Laundry Tray � <br /> Shower ' Z Washer 1 , <br /> Kitchen Sink I Water Heater <br /> Disposal / Water Softener <br /> Dishwasher � / Wet Bar / <br /> Sillcocks .Z � Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or apuliance 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 />