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N ' <br /> J <br /> . PLtJMB1NG.�TCTT;R��BEFI�G IldSTALL�L) ' <br /> FIXTURE BSMT 1 2 O'THER FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ^ � � Floor Drains �/_ � O <br /> oC llJ <br /> ��atory a 3 a Sewer Ejector <br /> c� <br /> Bathtub O � n La.undry Tray <br /> ll <br /> Shower ^ � I Washer ` <br /> a�� <br /> Kitchen Sink � � � Water Heater <br /> � <br /> Disposal � � � Water SoBener <br /> Dishwasher O ( � Wet Bar l <br /> Sillcocks � ,O � Miscellaneous <br /> ���c�c���c�.cu�,��orrEs� <br /> B�SEI�►C)F�-2002 STATE�'TA'I`�TE <br /> ❑ Yes,this section applies <br /> T'he replacement of only one R�sidential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a toffi1 cost of$500.00 or less;excludin�the cost of the f'vcture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Swcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Perroit Fee $ <br /> (Permit Fees Coutinued On Next Page) <br /> 2 <br />