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PL,�iJI�r�BING FIXTt1R�S BEING tNSTAI:LED <br /> FIXTURE BSMT ls 2 ° OTHER FIXTURE BSMT IST 2 O'THER <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 Water Heater I <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � Miscellaneous <br /> � PERMIT FEE CALCLTLATION(S) - <br /> �`BASED OFF -2002 STATE.STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> I. Does not require modification to electrical or gas service. <br /> "l. Has a total cost of�SO�.OU or iess; excludine the cost of tt��e 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 Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $_�,�(� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />