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. � \ , <br /> . ` <br /> � ��� � PLLTIVIBING FIXTURES BEING INSTALLED � '� � ����� <br /> FIXTURE BSivIT 1' 2 OTHER FI7�TURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> � � � � <br /> Lavatory � Sewer Ejector � <br /> � �. <br /> Bathtub C Laundry Tray �, � <br /> � � <br /> Shower W asher � <br /> C <br /> Kitchen Sink Water Heater c <br /> � <br /> Disposal Water Softener <br /> �, / c c <br /> Dishwasher � ` Wet Bar <br /> � �� � <br /> Sillcocks � Miscellaneous <br /> Z� � <br /> '� �� PERMIT FEE CALCULATION(S) � � � <br /> li BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture ar 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 Pernut $ 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 />