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. � <br /> PLUM�B�N(3 FIXT'URES�EING 1N3�'ALL�+,D _ <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � 2 Floor Drains <br /> _J <br /> Lavatory � Sewer Ejector <br /> Bathroom Laundry Tray <br /> � <br /> Shower I Washer I <br /> Kitchen Sink r Water Heater <br /> Disposal ' Water Softener <br /> Dishwasher � Wet Baz I <br /> Sillcocks � Miscellaneous <br /> F'LR1�ll.T F�C�L.�,�'I'IC����� <br /> BA�EU OF�-2Qf�.S"�'�`I�E S',�'�; <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or aonliance 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;excludine 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 Pemut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Nezt Page) <br /> 2 <br />