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, - --- <br /> P UI�1��ING FIXTURES BP;1NG INSTALLED <br /> FIXTURE BSMT ls 2 ° OTHER FIXTUI2E � BSMT ls 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washe* ; i <br /> i <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher We�Bar <br /> Sillcocks Miscellaneous <br /> I � _ <br /> � I�ERMIT FEE CALCULATION(S) <br /> j BASED OFF -2002 STATE STATUE_ <br /> � <br /> Yes,this section applies <br /> The replacement of only one Residentiai fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Uoes not require modificaiion to electrical or gas service. <br /> 2. Has a total cost o:$500.00 or less: exclu�ii�the�ost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeo�nex nr licensed plumbing contractor. <br /> Skip next section,if this applies; �ost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ � <br /> ��v <br /> (Permit Fees Continued On Next Page} <br /> 2 <br />