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PLU1�IlrTG FLXTUI�t,�S BEI�TG INST I�E13 '` � <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains � <br /> Lavatory Sewer Ejector <br /> Bathtub 1 Laundry Tray I <br /> Shower ` Washer I <br /> Kitchen Sink 1 Water Heater ' <br /> � <br /> Disposal 1 Water Softener 1 <br /> Dishwasher ` Wet Bar 1 <br /> Sillcocks � Miscellaneous <br /> pE����c�.eut�A�+�rr( 3 <br /> BRSED OFF-2402 S'TA'I'E�TATUE <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. D no require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the�xture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip ne�ct section,if this applies; Cost of Permit $ 15.00 <br /> State Surchar�e $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Negt Page) <br /> 2 <br />