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V � �' <br /> . = PLUMBING FIXTURES BEING INSTALLED =- <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE 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 <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> k��* � ��PERMIT FEE;CALCiJL'ATION(S) =�� '���� � ''��, ' �x <br /> 3 � zF'' r , ,a� �.,s.-�, . .... v+1:. "'. ... t..'�'Y r u�"Sif. , �� ;� � 3 �„sS-- - <br /> = .;:�.BASED..QFF =2002 STATE 3TATLTE..,,. ,-�= <br /> . : _ � .... � .. F <br /> � Yes,this section applies <br /> T'he 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;excludine 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 vU <br /> State Surcharge $ -�A � � <br /> Mail-In Fee(If Applicable) $ 2.00 . <br /> Total Permit Fee $� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />