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� r <br /> ° , <br /> �. PLLTMBING FIXTURES BEING INSTALLED , �, u�...� � - <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 T 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Wate <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks isce eous <br /> � �'' F�:T :� uPERMIT FEE�CALCULATION(S) �,� ���f - <br /> � �- :-- �_ t _ ,n__ .;BASED:9FF. �2002 STATE_STATUE . : ' � � <br /> Yes,this section applies <br /> The replacement of only one Residential fixture or ap�liance that meets all three of the following <br /> requuements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exciudine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ I.� <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $� <br />� (Permit Fees Continued On Next Page) <br /> 2 <br />