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� ' � � �r � <br /> � # �, � � :� ��., � y <br /> s, � � *� � <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 /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sil Icocks Miscellaneous <br /> ����e�+ x��x��t��������� R <br /> � ����� � �a�,�'�� � � � � 4 <br /> �.�, '� -�����. ���`�;�' � �" `��.. �, � <br /> ... _._ , . ,�.,., :s, <br /> f� Yes,this section applies <br /> The replacement of a Residential fixture or ap liance 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 fixhue 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) $ 1.50 <br /> Total Permit Fee $�_� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />