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. � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1`� 2��' OTHER FIXTURE BSMT lsr 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet /'� � Floor Drains � <br /> O� <br /> Lavatory n Sewer Ejector <br /> O� <br /> Bathtub � � Laundry Tray � <br /> Shower ` � Washer I <br /> I <br /> Kitchen Sink I Water Heater �� <br /> Disposal I Water Sofrener I <br /> Dishwasher ' Wet Bar ' I <br /> Sillcocks ,/� Miscellaneous I � }-)�'�� <br /> J <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 ap�liance that meets all three of the following <br /> requirements: <br /> I. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding 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 <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 />