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PLU�IBiN���TURES BET�G I�tSTALLEI? - <br /> FIXTURE 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 � r Washer / <br /> Kitchen Sink , Water Heater / <br /> Disposal � Water Softener <br /> Dishwasher � Wet Bar / <br /> Sillcocks � Miscellaneous <br /> �� <br /> PERMIT FFE CnLCULATION(S) <br /> BASEll OFF - 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 /> 1. 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 Surcharge $ 5.00 <br /> Mail-In Fee([f Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />