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F + <br /> �,;:PLUIVIBING.FLXTTJRES�BEING:INSTALLED ` <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 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 v <br /> l� <br /> Sillcocks Miscellaneous <br /> : � � , = h� � � , �'� PE�zrr���ai,c�,�.TzQ�r(s) :� t � ;i` g. <br /> �' � �° � �BA�SEIA OFF�.�2002;S.TATE�TA'T�v�` � ' : <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tluee of the following requirements: <br /> l. Does not require modification to electrical or gas setvice. <br /> 2. Has a total cost of$500.00 or less;excludinQ 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 Pern-ut $ 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 />