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__.____. <br /> PL,UMBING FIXTURES BEING TN':STALLED <br /> FIXTUR� BSMT' 1� 2 OT[IER FIXTURE F3SMT 1' 2 OTHER <br /> TYPE FL FL '1'YP�; FL FL <br /> Water Closet Floor Drain <br /> Lavatory Sewer �ectnr <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher �Vet Bar <br /> Sillcocks Miscellaneous <br /> � � �� �Vt;..w1 �� "�'�.c+ V�,'�''K'� "'�Ar�r�'`` � � `�j✓� <br /> � �,��,_�� � �v v J <br /> i..�..,.�,-11 �� c�nP �/ ��tic �'tra;�.,� ��r��✓, <br /> ' a � PCRMI'�TL���AL�T:7Lt�TION(S) <br /> � � � BA�ED OF�-2002 S�"A"F�STATUE <br /> � Yes,this section applies <br /> The replacement of only one Resiciential fixture or appliance that mects all three of the following <br /> rec�uirements: <br /> 1. Does not c•cquirc modifieation to cicctrical or gas seivice. <br /> 2. Has�total cost of$500.00 or less;excludink the cost of tl�c fixtiire o►•appliance:and <br /> 3, Is improved,installed or replaced by the homeowner or licensed plumbin�contractor. <br /> Skip i�ext section,if tl�is applies; Cost of Perniit $ 15.00 <br /> State Surcht�rge $ 5.00 <br /> Mail-In Fee(If Applicablc) $ 2.00 <br /> Total Permic Fee $ '�,�) <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />