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i <br /> � <br /> � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT I' 2' (?THER FIXTURE BSMT l 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> VVater Cioset 1 Floar Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dish�vasher 1��et Bar <br /> S i I Icocks M iseel laneous <br /> i <br /> � <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE STATUE <br /> �j Yes,this scction applies <br /> � , <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requ i rements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of�500.00 or less;excludinQ ihe 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 Perrnit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee{If App�icable) $ 2.00 <br /> Total Permit Fee S 20 00 <br /> i <br /> (Permii Fees Continued On Next Page) <br /> 2 <br />