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_ f � <br /> �� � PLUM�ING�IXTURE�S BEtNG�t�TA�,L.ED� � <br /> FIXTliRE BSMT 1't� 2��° O'I'HER FIXTURE BSMT ls 2� OTHER <br /> TYPE FL FL TYPE <br /> FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower <br /> Washer <br /> Kitchen Sink W'ater Heater <br /> i <br /> Disposal <br /> Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � PERMIT FEE CALCULATION(S) <br /> ` BAS��D OFF -2002 STAT� STATUE <br /> �' Yes.this section applies <br /> The repiacement of only one Residential fixture or a�pliance 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;excludin�the cost of the fixture or appliance:and <br /> 3. Is imprvved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Slcip 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 $ ZZ-U� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />