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�LUMBING FIX'I'L3ItES BEIP+fG INSTALL�1� '` <br /> FIXTURE BSMT 1 T 2ND OTHER FIXTURE BSMT 1 T ZND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Z ' Floor Drains <br /> Lavatory .3 � 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 <br /> PERMIT FE�CA�.CULATIOI�(S) <br /> '`BASEI7 OFF -�002 ST.ATE STATU� <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;excludine 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 Negt Page) <br /> 2 <br />