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,.�..-' .�.�.����;�'��..._ ._; .. .. . :����`�1�'�.��.�L.��,- ..�.. ..��''��"�.�- _��. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 1 3 Floor Drains 1 <br /> Lavatory 1 1 5 Sewer Ejector <br /> Bathroom 1 1 3 Laundry Tray 1 <br /> Shower 1 1 Washer 1 <br /> Kitchen Sink 1 Water Heater 1 <br /> Disposal 1 Water Softener 1 <br /> Dishwasher 1 Wet Baz 1 <br /> Sillcocks 2 Miscellaneous <br /> � 3 ��� ' p��.1�t�'I`�� �.':���� , � � <br /> � , <br /> � , � ..�.���`�.�C���� �`��`ATE��'AT`L�.TE _ � � � <br /> � � � ��., x:� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a lpp iance that meets all three of the following requirements: <br /> 1. Does not require modificafion 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 Nezt Page) <br /> 2 <br />