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Y.' <br /> PLUMBING FIXTURES BEING INSTALLED, <br /> � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT ls OTHER <br /> T�'E FL FL TYPE FL L <br /> Water Closet Floor Drains I <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower w Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks , Miscellaneous <br /> PERMIT FEE CALCULATiON(S) <br /> BASED OFF -2002 STATE STATiJE <br /> ❑ Yes,this section applies <br /> The replacement of onty one Residential fixture or appliance that meets all three of the followu g <br /> requirements: , <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;cxcludine the cost of the fixture or appliance: nd <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contra tor. <br /> Skip next section,if this applies; Cost of Pernut' $ 15.�0 <br /> State Surcharge $ �-- 1, U�� <br /> 1VIai1-In Fee(If Applicable) $ 2.G0� � l <br /> Total Permit Fee $ i� <br /> � <br /> f, <br /> ... ' I <br /> (Permit Fees Continued On Next Page) I <br /> • , 2 <br /> • , <br />