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4 <br /> PLUMBING FI.XTURES BEING INSTALLED .. <br /> FIXTURE BSMT lsr 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 2 2 Floor Drains / <br /> Lavatory 3 6 <br /> 1 Sewer Ejector <br /> Bathtub ' Laundry Tray <br /> Shower f Washer <br /> Kitchen Sink i Water Heater <br /> Disposal Water Softener <br /> Dishwasher I Wet Bar <br /> Sillcocks Miscellaneous <br /> BASED OFFr-,2002 STATE STATUE` <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip 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 Next Page) <br /> 2 <br />