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� FTiU1�73ING FI�TLIRFS BE.ING INSTALLED <br /> FIXTURE ' BSMT 15 � 2'� OTHER—TFIXTURE BSMT ]S 2 OTHER <br /> TYPE FL i T�l, i TYP'E FI, FL <br /> -----� ---- L--- — <br /> Water Closet � Floor Drains <br /> i <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower �— Washer <br /> Kitchen Sink i � I Water Heater I <br /> � I <br /> Disposal —�Water Softener <br /> � <br /> Dishwasher Wet Bar <br /> � _ I <br /> Sillcocks i Miscellaneous <br /> � <br /> i �'ERMIT FEE CALCULATION(S) <br /> _ � BASED OFF - 2002 STATE STATLTE <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 requ;re rr,�dificatic;,:o�lec:;;�al c;r gas service. <br /> 2. Has a total cost of$500.00 or less; excludine 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 $G��'✓7 „ T� <br /> �C�(J�.� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />