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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 � 2 3 Floor Drains 2 <br /> Lavatory � 3 3 Sewer Ejector <br /> Bathtub � Laundry Tray � <br /> Shower � 1 3 Washer � <br /> Kitchen Sink 2 Water Heater 2 <br /> Disposal � Water Softener � <br /> Dishwasher � Wet Bar � 1 <br /> Sillcocks 2 Miscellaneous <br /> s � �: <br /> „5 <br /> 0 Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the fo(lowing 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 Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />