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, <br /> �' ,-» ', PLUMBING FIXTURES BElNG Il�TSTALLED . �`�` <br /> < �,: <br /> FI�TLJRE 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 W asher i <br /> c <br /> Kitchen Sink � Water Heater <br /> Disposal � 1 Water Softener <br /> t <br /> Dishwasher ` Wet Bar <br /> Sillcocks Miscellaneous <br /> � � � � � PERMIT FEE CALCL�LATION(S) � � <br /> BASED �JFF - 2002 STATE STATUE I <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; excluding 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(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />