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� <br /> PLUMBING FIXTURES BE1NG 1NSTALLED <br /> FIXTURE BSMT 1 2' OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains / <br /> ( <br /> Lavatory � � Sewer Ejector <br /> Bathtub � Laundry Tray � <br /> Shower f � Washer � <br /> Kitchen Sink � Water Heater ! <br /> / <br /> Disposal ( Water Softener <br /> Dishwasher / Wet Bar ` <br /> / <br /> Sillcocks Miscellaneous <br /> �� � � PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yejs��s section applies <br /> \ <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 or gas service. <br /> 2. Has a'�otal cost of$500.00 or less; excludina 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 $ l 5.00 <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 />