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,� • <br /> . <br /> PLUMBING FIXTURES BEIl*TG INSTALLED <br /> FIXTURE BSMT 1ST 2 OTHER 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 her <br /> Kitchen Sink ater Heater ( <br /> ! <br /> Disposal Water So ener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <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 a�pliance 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 /> Sk:p next section,if this applies; Cost of Fermit $ 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 />