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ibt <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1" 2ND OTHER FIXTURE BSMT 1S' 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains L <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 FEE CALCULATIONS) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following 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--ls i , ' -replaced-by-the-herneo r-er-lieensed-een• . o . <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In--Fee-(If ppli able) $ -1-50 ----- <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />