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, <br /> . i ' <br /> . .. . .- . ... <br /> `' : '�LtJMBINC FIX�'LTRES BEII�G T�1ST�.LLED. . =: <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 /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal � Water Softener <br /> er Wet Bar <br /> Silicocks Miscellaneous <br /> � � PEx������c�cut,aTror��s3 ' <br /> � ; � �- <br /> _ BASED O�'F�=�002:;ST.ATE ST.s4:T�E.... =.` ..._ �. ' <br /> , - ,_; , <br /> .._:. ...., <br /> ! �J Yes,this section applies <br /> ✓ � <br /> The replacement of oniy one Residential fiarture or appliance that meets all three of the following <br /> requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Ship next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $�� <br /> (Permit Fees Continued On Nezt�age) <br /> 2 <br />