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PLUMBING FIXTURES BEING INSTALLED <br /> FIXT'URE BSMT 1 2 OTF�R FIXTURE BSMT 1 2 OTI�R <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 1 Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ' FERh+IIT FEE CAt.C�t.}'LA"���� <br /> �t�S�1,3 E>�F-2�2 STA►T����.TC� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludins the cost of the fi�eture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed conhactor. <br /> Skip neact section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />