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k <br /> , PLUMBING FIXTURES BEING INSTALLED <br /> 2 OTHER FIXTURE BSMT 1 ?' OTHER <br /> FIXTL'RE BSMT 1 TYPE � FL FL <br /> ' TYPE FL FL <br /> '� Water Closet � <br /> Floor Drains <br /> Sewer Ejector <br /> , Lavatory <br /> Laundry Tray <br /> I Bathtub i <br /> W asher � � <br /> � � <br /> ' Sho��er � � <br /> Water Heater i <br /> Kitchen Sink ' <br /> � Water Softener i <br /> Disposal � �I I I i I <br /> Wet Bar 'I <br /> Dish��asher / <br /> ' cellaneous i <br /> M�s <br /> �� Sillcocks � <br /> ' I� <br /> PERMIT FEE CALCULATION(S) <br /> I BASED OFF - 2002 STATE STATUE <br /> U Y'es,this section applies <br /> The replacement of only one Residentiai fixture or appliance that meets all three of the follo�ving <br /> requirements: <br /> 1. Does not rec�uire 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 /> ;. is ;n,nr�ved, installed or replaced by the homeowner or licensed plumbin�contractor. <br /> $ 15.00 <br /> Skip next section, if this applies; State S uchar�ge $ � � 5.00 <br /> Mail-In f ee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> I i <br /> ,� <br /> (Permit Fees Continued On Next Page) <br /> 2 I <br />