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PLUMBING FIXTURES BEING INSTALLED <br /> FIX'I�URL; I3SM"I� l��'� 2VD O"I�IIL;R I�IX'I�URG 13SM"f l�� 2'�D O"I�III;R <br /> "f�YPL FL FL TYPL I'L FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Gjector <br /> Bathtub Laundry Tray <br /> Showcr W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener /� <br /> (� <br /> Dishwasher Wet[3ar <br /> Sillcocks M iscellaneous <br /> � . <br /> PERM[T FEE CALCULATION(S) <br /> ____ _BASED OFF -2002 STATE STATUE <br /> ❑ Ycs,this scction applies <br /> 7'hc replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> l. Does not require modifiication to electrical or gas service. <br /> 2. Has a total cost ot�$500.00 or less;excludina the cost of the tixture or appliance: and <br /> 3. Is improvcd, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />