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, . ` <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 /> l <br /> Bathtub / � Laundry Tray � 1 <br /> 6 <br /> Shower / Washer l <br /> ! <br /> Kitchen Sink � Water Heater � <br /> Disposal ( Water Softener 1 <br /> Dishwasher / Wet Bar <br /> [ <br /> Sillcocks � Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or anpliance that meets all three of the following requirements: <br /> 1. Does not require modificarion 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 con�ractor. <br /> Skip next section,if this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />