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r <br /> ' �, <br /> �.,.;, : <br /> . . . PLUMBING,'FIXTIJRES BEING TNS�ALLED � . <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Draais <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 /> ,'� � =PERIVITT�`EE CA�;C�.A;T�Q�T(S) ,,' � = � , , : <br /> � 3. , - s -, .. <br /> : � �_ � , ., . . . r � . <br /> � > ' BASED QFF. ;2042:'ST,ATE ST.ATUE �. , °`. '` ; <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tlu�ee of the following requirements: <br /> 1. Does not require modification to elech�ical or gas seivice. <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 Permit $ 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 />