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! <br /> � �� � PLUMBING FIXTURES��BEING INSTALLED � � � � �� ��� � <br /> FIXTURE BSMT l'� 2�D OTHER FIXTURE E3SMT 1 � 2�D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry"I'ray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener , / <br /> ri <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ���� � � PERMIT FEE GALCULATION(S)� ��� <br /> � � � BASED OFF - 2002�STATE STATUB� �� ��� � <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture ar appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical ar gas service. <br /> 2. Has a total cost of$500.00 or less; excludin�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 Pennit $ 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 />