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,� - <br /> PLUMQING FIXTURES BEING INSTALLED �� � <br /> FIXTURE BSMT ls� 2"D OTHER FIXTURE BSMT ls� 2"D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub I Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink � Water Heater <br /> Disposal I Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> ` � �2 ����,es <br /> --� ./� vn w►o�rin `�ar ��,� �� w1�S�- bo- rc�.-, <br /> � <br /> �S "�.�� d'.�� 1'��d"Le, S�1a�n�2T �'�blh� l h r�aS�' bd�roo�►,,. <br /> PERMII'F�E Ct�LCULATION(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 /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�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 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 />