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i <br /> PLtJNt-BII�TG FIXTURES BEIl��G Ii�STALLED� <br /> FI�TURE BSMT 1 2'��D OTHER FTXTURE SSMT isr 2� OTHER <br /> TYPE FL FL Tl'PE FL FL <br /> Water Closet � Floor Drains <br /> � <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower 1��asher <br /> � � I <br /> Kitchen Siilk Water Heater <br /> Disposa] ��'ater Softener <br /> ' <br /> Dishwasher Wet Bar <br /> Silicocks Miscellaneous <br /> � �� � � PERMIT FEE C�LCULATION(S) � � � �� � � <br /> BASED C3FF -2002 STaTE STATLE <br /> ❑ Yes,this section applies <br /> The replacement of or+?y ot�e Residential fixture or�pliance that meets all three of the follo��in� <br /> requirements: <br /> l. Does not�equire modification to electrica]or�as service. <br /> 2. Has a total cost of$500.00 or less;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved, installed or replaced by the homeov✓ner or licensed plumbin�contractor. <br /> Sl:ip next section,Sfthis applies; Cost ofPermit $ 1�.00 <br /> State Surchar�e $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> "E'otal Permit�'ee �� <br /> (Perrr�it�'ees Co��itieu�ec� Q'� I�e�:fi E'��e} <br /> 2 <br />