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PLUMBING FIXTURE�S BEING INSTALLED ��` � � � <br /> FIXTURE BSMT 1 2� OTHER FIXTURE BSMT 1 r 2ND 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 I <br /> �NQ� SuP P 1`J I�r� --l�01��v���e '� ;�r����n m��h�n� . <br /> � I reQ�y i ��-�, ) ��� by �� e C�P�n}�. <br /> ✓��5�-G I I (�e� � �b�/ ��� � U,�,b��� <br /> � , - �J ��bv�lue= <br /> PERMIT FEE GALCULATION(S) � �� � <br /> BASED OFF - 2002 S"CATE S"i'ATUE � ��� <br /> ❑ Yes,this section applies <br /> The 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;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 />