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, , <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 ' 2ND OTHER FIXTURE BSMT 1 � 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains � <br /> Lavatory + c-� Sewer Ejector <br /> f� <br /> Bathtub � Laundry Tray j <br /> \ <br /> Shower � Washer ( <br /> Kitchen Sink f Water Heater � <br /> [ <br /> Disposal / Water Softener � <br /> l <br /> Dishwasher � Wet Bar <br /> Sillcocks � Miscellaneous <br /> �r" <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or a�pliance 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 contractar. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Con6nued On Next Page) <br /> 2 <br />