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. <br /> r <br /> PLUMBING FIXTURES BEING�NSTI�LL�D <br /> FIXT'URE BSMT 1 2 OTI-�R FIXTURE BSMT 1 2 OTI�R <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 /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> : PERA�I'�F�,GA�.CLJI.ATI�I(S) : <br /> BAS���-�0�2 STA'1'�STI�TUE _ <br /> ❑ Yes,this section applies <br /> T'he replacement of a Residential fixture or appliance 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;excludina the cost of the fixture 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) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />