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. � � <br /> � <br /> PLUMBII�G FIXTURES"BEIl�TG INSTALLED <br /> FIXTURE BSMT 1 2� ' OTHER FIXTURE BSMT 1� 2' OTHER <br /> TYPE FL FL 5�� TYPE FL FL <br /> Water Closet r� � Floor Drains <br /> � <br /> Lavatory � Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower J Washer <br /> l <br /> Kitchen Sink � Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) � <br /> BASED OFF - 2002 STATE STATUE '� <br /> ❑ Yes,this section applies <br /> The replacement of onl}�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;exciudin�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 />