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PL IIBTNFJXTLJRR S;;*BEING;INSTALLED = ?" <br /> FIXTURE BSMT I s r 2ND OTHER FIXTURE BSMT lsr 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 2 Floor Drains I <br /> Lavatory 3 Sewer Ejector <br /> Bathtub / Laundry Tray <br /> Shower q j Washer <br /> 1 I <br /> Kitchen Sink Water Heater <br /> Disposal ' Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 46,4.42 <br /> r� y�:�nad,r� �i a .:y w."yg�. �,b&y s � "`t� � 5���� <br /> 99�y I2 V t ®'` <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 />