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� <br /> . , <br /> ������- � � PLUMBING FIXTURES�BETNG 1NSTALLED �� � � � <br /> FIXTURE BSMT 1 2' OTF3ER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYP� FL PL <br /> Water Closet � ' Floor Drains <br /> Lavatory i Se���er Ejector <br /> Bathtub � Laundry Tray <br /> Shower Washer <br /> KiYchen Sink Water Heater <br /> Disposal � Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OI'F - 2002 STAT� STATUE <br /> ❑ Yes, this section applies <br /> The replaceizlent of a Residentill fixhn-e or appliance that nleets all fln�ee of the following requirements: <br /> 1. Does not require modification to elech-ical or gas service. <br /> 2. Has a total cost of$�00.00 or less; excludina the cost of the fxture or appliance: and <br /> 3. Is improved, installed or replaced by the houieowner or licensed couh�actor. <br /> S]<ip next section, if this applies; CosC of Perinit $ 15.00 <br /> State Surcharge � .�0 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> 'Total Pernut Fee � <br /> (Pe►•nlit b'ees Continued On Neat I'age) <br /> � <br />