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``.�� ,� Lxn�� s'�"�,���. ���..�,�ra�, s���..,,� <br /> FtXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <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 SoBener <br /> Dishwasher ' Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATICJN(S) <br /> BASED OPF -2002 STATE STATUE � � <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 /> l. Does not require modification to electrical or gas service. � <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture 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 Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ 2Z-u� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />