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, � , <br /> _ PLUMBING FIXTURES BEING INS'I'�,�:���;. <br /> ------ <br /> F[XTURE BSMT l�' 2�`D 07'HER FIXTURE BSMT 1 2ND 01'HER <br /> TYPE FL FL TYPE <br /> FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> I <br /> Kitchen Sink�j Water Heater <br /> Disposal � � <br /> ; Water Softener <br /> Dishwasher � Wet Bar <br /> � <br /> Sillcocks Miscellaneous <br /> � <br /> r-------__. <br /> PERMIT FEE CALCU�;AT20N(S) � �� <br /> _ _BASED OFF -2002 STATE STATUE� � �� <br /> � Yes,this section applies <br /> The repiacemcnt of only one Residential fixture or anoliance that meets all three of the fo!lowing <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> Z. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance:and <br /> 3• Is improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip ne�t section, ifthis applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(IfApplicable) $ 2.00 <br /> 7'otal Permit Fee $ ZZ Vl� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />