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r <br /> t <br /> PLU�ViBII���FI�TURES t�EI1�T�INST:ALLEL� <br /> FIXTURE BSMT 1 2ND OTHER FIXTURE BSMT 15T 2 OTHER <br /> TYPE FL FL T1'PE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory Se���er Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Siilk Water Heater � <br /> Disposa] Water Softener <br /> Dishwasher VJet Bar <br /> Sillcocks Miscellaneous <br /> �'ERMITFEE CALCULATIQI�,T(S) "' <br /> BASED OFF -2002 ST�TE STATtiE ':, <br /> � Yes,this section appiies <br /> The replacement of or.@y one Residential fia�ture or ap�liance that meets all three of the following <br /> requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of��00.00 or less;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbin�contractor. <br /> Sl:ip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-in Fee(If Applicable) $ 2.00 <br /> �'otzl Permet�'ee � 'l�Z'l�J <br /> (PeczrEt�ees�o��ti�:�ed�l'r� �Ie�:t�'a�e) <br /> 2 <br />