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, <br /> � � . <br /> <` <br /> PLUMBING FIXTURES BEING INSTALLED ; <br /> FIXTURE BSMT 15 2 OTHER FIXTURE BSMT IS 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 <br /> PERMIT FEE CALCIJI.ATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of onty 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$SU0.00 or less;cxcludine 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 /> f.. <br /> (Permit Fees Continued On Next Page) <br /> ` • . . 2 <br /> , � <br />