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. '� <br /> � PLUMB G FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 OTI-IER FIXTURE BSMT 1 2 OTi�R <br /> TYPE 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 /> Dishwasher Wet Bar <br /> sillcocks Mis��eous � <br /> �' G�QOC�Nl.� L�'G�L .Sj/1'I�ILG. Bd/L�/� 2dD�'/. <br /> t��r����'a R�z �h/3�o� �--h�-,:4��e���' �� <br /> " ��r�.�.�-ve. <br /> fc'G2ar �/7379/ �ha�s'�,ev�'S T�� N��n�/Gi <br /> T�ST�� O�• <br /> P RNIIT`FEE CALCULATION(S) > <br /> BA ED OFF=2002 STATE S�ATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Resid�ntial fixture or appliance tbat meets all three of the following <br /> requirements: <br /> 1. Does not require mo fication to electrical or gas service. <br /> 2. Has a total cost of$5 0.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is unproved,installed or repiaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if 's applies; Cost of Petmit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Nezt age) <br /> 2 <br />