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i <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2' � OTHER FIXTURE BSMT 1 2' OTHER <br /> TYPE FL FL � TYPE FL FL <br /> ____.___---_ ------- ..______ _..___._ . ___--_ __. <br /> V�'ater Closet � � Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub I 1 Laundry•Tray l <br /> Shower I W'asher <br /> Kitcheu Sink ' �Vater Heater <br /> I3isposal �L%ater Softener <br /> Dishwasher VJet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ I'es,this section applies <br /> The replacement of on 1�•one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or sas service. <br /> .'.. Has a total cost of S500.00 or less; escludinst the cost of the fi�cture or appliance: and <br /> 3. Is impro�ed,installed or replaced by the homeo��ner o.licensed plumbing contractar. <br /> Skip next section,if this applies; Cost of Petmit � 15.00 <br /> State Surchar¢e S 5.00 <br /> Mail-In Fee(If Applicable) S 2.00 <br /> Total Permit F ee S <br /> (Permit Fees Continned On Nezt Page) <br /> 2 <br />