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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT ]sr ?no '—_ — --- --- _— — <br /> O7HER FIXTURE BSMT 1'� 2`D OTHER <br /> � TYPE FL FL TYPF FL FL <br /> � <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower --- Washer <br /> Kitchen Sink Water Heater <br /> Disposal � <br /> Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellancous <br /> PERMIT FEE CALCULATION(S) � <br /> f BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applics <br /> The replacement of unly one Residential tixture or ap�liance that meets all three of the following <br /> requirements: <br /> I. Does not require modification to electricai or gas service. <br /> 2. Has a total cost of 5500.00 or Icss;excludinz the cost of thc fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,ii�this applies: Cost of Permit � 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee g �v <br /> �2, - <br /> (Permit Fees Cuntinued On Next Pabe) <br /> 2 <br />