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� <br /> PLUMI3INGFIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1' 2' OTHER FIITURE BSy1T 1' 2 OTHER <br /> TYPE PL PL TYP� FL PL <br /> Water Closet ( j � Floor Drains � <br /> / <br /> Lavatory I 1 3 Se�ver Ejector <br /> Bathtub 1 1 I Laundry Tray � � <br /> � <br /> Sho�ver / W asher � <br /> Kitcheu Sink 1 Water Heater � <br /> Disposal / Water Softener � <br /> Dishwasher ` Wet Bar r <br /> / <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> � ❑ Yes, this section applies <br /> The replacemeut of a Residential fixhire or appliance that meets all tlu•ee of the following requirements: <br /> 1. Does not require�nodification to elech�iea] or�as seivice. <br /> 2. Has a total cost of$500.00 or less; excludin��the cost of the fixture or appliance: anci <br /> 3. Is improved, installed or replaced by the homeowner or licensed conh�actor. <br /> Skip next section, if fllis applies; Cost of Pernut $ I5.00 <br /> State Surcharge � .50 <br /> Mail-In Fee (If Applicable) $ 1.50 <br /> Total Permit Fee � <br /> (Permit Fees Continued On Next Page) <br /> � <br />