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.PLUMBING FIXTURES.BEING INSTALLED <br /> FIXTURE BSMT ls' 2N1) OTHER FIXTURE BSMT ls' 2ND OTHER <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 /> /.Lo(,' 3 cr S 1'cte. is s d— ((u s ( g /soca- Fwt- <br /> ocii, <br /> At.„0,44. <br /> ra P R VIZI FEE:.CAL r‘icr—tcs <br /> a s a s <br /> t • <br /> ..BASEI} F 200 .STASI`ET�'TUE 'F. w .. <br /> ❑ Yes,this section applies <br /> The 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; excluding 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) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />