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PLUMBING FIXTURES BEING INSTALLED � � �� <br /> FIXTURE BSMT I��r 2�1D OTHER FIXTURE BSMT 1' � 2�D OTE�IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I I � Floor Drains � <br /> � <br /> Lavatory 1 � :-� Sewer Ejector <br /> I <br /> Bathtub � Laundry Tray <br /> Shower � Washer i <br /> 1 <br /> Kitchen Sink � Water Heater + <br /> I <br /> Disposal I Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks i Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The repiacement 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. ls improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section, if this applies; Cost of PenniC $ 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 />