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PLUMBING FIXTURES BEING INSTALLED <br /> FTXT'[JRF. RSMT l` 2' OTHF.R FiXT[TRF. RSMT l` 2 OTHF.R <br /> TYYIi I�L 1�L fYY1: 1�L FL <br /> Water Closet � Floor Th-ains <br /> Lavatorc � Se��er Ejector <br /> 13alhroom I Launcin' "lray I <br /> Sho���er Washer I <br /> Kitchcn Su-ih � Water l leater <br /> llisposal I Water Softcncr <br /> T�ish���asher ' Wet Rar ' <br /> Sillcocks ` Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The re��lacement of a Resi�lential tiarture or appliance that meets all three of the folla��ing reyuirements: <br /> l. lloes not require modilication to electricel or gas scrvice. <br /> 2. Has a total cost of$500.00 or less;escludina the cost of the fixture or appliance:and <br /> �. Is improved,inst��lled or replace�i b� the homeo��T�er or licensed contractor. <br /> Skip nest section,if this applies; Cost ot Pennit $ 15.U0 <br /> State Surcharge $ �0 <br /> Mail-Inl�cc(Il Applic��blc} � 1.�0 <br /> Total Permit Fce S <br /> (Permit Fces Continued On Nect Pagc) <br /> 2 <br />