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1 <br /> . <br /> . ` <br /> '.:; PLUMBING FSXTURES 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 � Water Heater <br /> Disposal / Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous � <br /> �j. �.G ��� <br /> �� C's� <br /> � PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE j <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or ap�liance 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; excludinQ 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 /> (Permit Fees Continued On Next Page) , <br /> 2 <br />