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_ Jan 06 11 04;OOp Microsoft 5076457654 p.2 <br /> 1 <br /> I <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE HSMT 1 ' 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL T'YPE FL FL <br /> � Water Close! j Floor Drains <br /> I <br /> Lavatory j 5ewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower Washer <br /> � <br /> ( f�itchen Sink I V1/ater Heater i <br /> Disposal ( Water Softener i <br /> Dishwasher t Wet Bar <br /> [ <br /> � Sillcocks { Misce3lane�us <br /> � <br /> � <br /> PERMIT FE�CALCULA'�ION(S) <br /> BASED OFF -2002 STA1 E STATUE <br /> � Yes,this section appl�es <br /> The replacement o a Residenfial fixture ar annliance that meets all three oFthe fotlowing requirements: <br /> 1. Does ot require modi6cation to electrical or gas service. <br /> 2_ Has total cost of$500.00 or less;excludin�the cost of the fixture ar appliance:and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> I Skip next section,if this applies; Cost of Permit S ]S.QO <br /> State S�crcharge $ 5.00 <br /> i Mail-In Fee(If Applicable) $ 2.00 <br /> Tota[Pcrmit Fee S <br /> I <br /> I <br /> � (Permit Fees Con6nued On N'ext Page} <br /> Z <br /> i <br />