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� <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI-�R <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 2 <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <br /> ❑ Yes,this section applies'' <br /> The replacement of only one Residentia ixture or a liance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to ele 'cal or gas service. <br /> 2. Has a total cost of$500.00 or less;exc in the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the h eowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of it $ 15.00 <br /> State Surchar $ 5.00 <br /> Mail-In Fee(If A icable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />