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� PLUMBING FIXTURES BEING INSTA�L�T� ��� <br /> FiXTURE RSM"T l�� 2ND O"I�III?R FIXTURE BSMT 1 2"D O"1'HER <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 <br /> Sillcocks Miscellaneous <br /> -- -- - --- - � �� a�-e- C i►�on �I �Tei' <br /> PERMIT FEE CALCL�LATION(,' � ' <br /> � BASF_,D OFF - 2002 STATE ST�UI; <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or a lia ce that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to elec ical or gas service. <br /> 2. Has a total cost of$500.00 or less; cludin=the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replace y the homeowner or licensed plumbing contractor. <br /> Skip next section, if this ap �es; Cost of Pern�it $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continucd O ext Page) <br /> 2 <br />