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PLUMBING FIXTURES BEING INSTALLED <br /> FIYTURE BS1�iT 1 2� OTHER FIYTURE BS14fT 1 T OTHER ' <br /> TYPE FL FL TYPE FL FL <br /> �L'ater Closet � � � � F1oorDrains <br /> Lavatory I Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower � �Vasher <br /> Kitchm Sink W'ater Heater <br /> Disposal Water Softener <br /> Dishw�asher VVet Bar ' <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ 1'es,this sedion applies <br /> The replacement of only one Residential fixture a�appliance that meets all three of the follo��ing <br /> requirements: <br /> 1. Does not require modification to electrical or gas ser�-ice. <br /> 2. Has a total cosi of S�OO.uG or less; eYcludins�the cost of the fixture or appliance: and <br /> 3. Is impro�ed,installed or replaced by the homeov�=ner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit S 15.00 <br /> State Surcharee S 5.00 <br /> Mail-In Fee(If Applicable) S :..00 <br /> Total PermitFee S <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />