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� <br /> � <br /> ` � �' �: PLUlVIBING;FIXTLTRES`:BEING INSTAI,LED ° ° : " <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 <br /> Sillcocks Miscellaneous <br /> ` � 4 �� FE `R1VI�T'EEE GA.�.CI.�L;A,TIO�T(S) s ; - �- <br /> �.; ,, ...:�" _BASED OF�y 2002;'STAT��STATL�E:: . <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or ap hp 'ance that meets all tlu�ee of the following requirements: <br /> 1. Does not require modification to electrical or gas seivice. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: and <br /> 3. Is innproved,installed or replaced by the homeowner or licensed conh•actor. <br /> Skip next section,if this applies; Cost of Pernut $ 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 />