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� � <br /> , <br /> � <br /> PLUMBING FIXTURES BE1NG INSTALLED ' <br /> FIXT'URE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 4 Ftoor Drains 5 <br /> Lavatory 4 Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> 2 1 <br /> Kitchen Sink Water Heater <br /> 3 2 <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 1 Urinal 2 <br /> PER�rIIT FEE CALCiJLATI�N(S) , <br /> BASED OFF-2002 STATE STATUE ' <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or a�giance that meets all three of the following <br /> requirements: <br /> 1. es not require modification to elecU-ical 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 ne�ct section,if this applies; Cost of Permit S 15•00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> � <br /> (Permlt Fees Cootinued On Next Page) <br /> 2 <br />