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126C454587 <br /> FIXTURE FiSh1T 1' 2 OTHER FIX'I'URF. BSM7' 1' 2 OTHER <br /> TYPG EL PL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Showcr Washer <br /> Kitchen Sink Water Heater <br /> Disposal � Wa[er SoRener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscell:uieous <br /> ` I'f RivttT�l E l'r11 Ct1Li�CION(S? Y � ..~ <br /> ,.u", ',`�.� BASEIa f�FI' �2UO2 S1'ATE S`I"ATUE � "E ' � � '��r° <br /> ❑ l'es,diis sectirrn applies <br /> The replacement of only one Residential fixtare or appliance that meets alI three of the foltowing <br /> rey u i rcments: <br /> 1. Does not require modification to clectrical ar gas service. <br /> 2. Has a total cost of$SOO.QO or Iess;excludina the cost of the fixture or appliance:and <br /> 3. Is improved,installad or replaced by the homeawner or licensed plumbing contractor. <br /> Skip next section,if this applies: Cost of Permit $ I5,00 <br /> State Surcharge S 5.00 <br /> Mail-In Fee([f Applicable) $ 2.00 <br /> Total Permit Fee $ 22A0 <br /> (PermiC Fees ConYinued On Nezt Page) <br /> 2 <br />