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, PLUMBING FIXTCIRCS BCING INSTALLED <br /> FIXTURE f3SMT I'� 2�D OTHER FIX"I'URE BSMT 1`T 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washcr <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener 1 <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE C.ALCULATION(S) : <br /> BASED OFF' - 2002 S'TATF STA'1�li C <br /> ❑ Yes,this section lies <br /> The replacement of only one Resi tial fixture or a liance that s all three of the following <br /> requirements: <br /> � <br /> 1. Does not require modification to e �cal or gas service. <br /> 2. Has a total cost of$500.00 or I ;exc �n the cost of the fixture or appliance: and <br /> 3. Is improved,installed o� aced by the ho wner or licensed plumbing contractor. <br /> % <br /> Skip next sectio this applies; Cost of Permi $ I5.00 <br /> State Surcharge $ 5.00 <br /> ,� Mail-In Fee(If Applic e) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />