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� ��;`� ��� �PLLTMBING�FIXTURES�BEING INST�ALLED �� � ��'� .� ����. <br /> �� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2' OTHER <br /> TYPE y� FL FL TYPE FL FL <br /> �.+/y <br /> Water Closet Floor Drains <br /> � / <br /> Lavatory � Sewer Ejector <br /> / <br /> Bathtub Laundry Tray <br /> ! <br /> Shower � ` Washer / <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> I PERMIT FEE CALCULATION(S) � � �� <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appiiance 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; 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 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 $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />