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!� � ' <br /> � <br /> ' - , PLUIvIB1NG FIXTURES BEIN�INSTALLEI�: : : " <br /> FIXTURE BSMT 1 2� OTHER FI7%TURE BSMT 1 2 OTHER <br /> TYPE FL FL T1'PE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater , <br /> Disposal Water Softener I <br /> Dishwasher Wet Bar <br /> Sil lcocks Miscellaneous <br /> PERNIIT FEE CALCULATION.S ` <br /> O <br /> BASED`OFF-2002 STATE S3'�T�E. ', <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fia�ture or appliance that meets all three of the foliowin� <br /> requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. f s improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Sl:ip next section,ifthis applies; Cost ofPermit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-Tn Fee(If Applicable) $ 2.00 <br /> Totsl Permit Fee $ <br /> (Pe�tn�t�'ees Cootti�uuec3 �n Ide�t Pa�e) <br /> 2 <br />