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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 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 i Water Heater <br /> I <br /> Disposal i Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <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; excludin�the cost of the fixture or appliance: and <br /> '--Is-i�gr-o�ed��stalled-or-Fep�ased�3�tl���eo�eF-er-�ic-�sec�-sont�-ac-to . <br /> Skip next section,if this applies; Cost of Pemut $ 15.00 <br /> State Surcharge $ .50 <br /> - ,�arl-�x-�e�-(I�Applicable) � -1.-50— <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> �i:..... P:� . <br /> I � <br /> �i � <br /> � �''• <br /> 2 u <br /> ,� <br /> ; 4 � � <br /> na ��'. <br /> _ . II � �I'�. �' � . <br />