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� <br /> � <br /> t <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT l 2 OTHER F�IXPTE RE BSMT � �L OTHER <br /> �,pE FL FL <br /> Water Closet <br /> Floor Drains <br /> Sewer Ejector <br /> Lavatory <br /> Bathtub �un�T�y <br /> Washer <br /> Shower <br /> Ititchen Sink Water Neater x <br /> / � <br /> Disposal <br /> �yater Softener <br /> Dishwasher <br /> Wet Bar <br /> Miscellaneous <br /> Sillcocks <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> � Yes,this section applies <br /> The replacement of only one Residential fixture or avvliance that meets all three of the following <br /> requirements: <br /> � 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 repiaced bY the homeowner or licensed plumbing contractor. <br /> Cost of Permit $ 15.00 <br /> Skip next section,if this applies; � 5.00 <br /> State Surcharge <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee s_`� <br /> (Permit Fees Confinued On Next Page) <br /> z <br />