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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2� OTHER FI�'TL)RE BSMT ls 2- OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet l Floor Drains <br /> La`�atan� � Se«�er E jector <br /> Bathtub Laundcti Tra�� <br /> � - - <br /> Sho«�er Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Ivliscellaneous <br /> PERI�'IIT FEE CALCUL,ATION(S) <br /> BaSED OFF - 2002 STATE STATUE <br /> ❑ Ycs_ this scction applics <br /> The replacement of on1�-onc Residential fixture or anpliance tlut meets all tlu�ee of the follo«ing <br /> requirements: <br /> 1. Does not require modification to electrical or gas sen-ice. <br /> 2. Has a total cost of$SOO.OI)or less:eacludin�;flie cost of the filture or appliance: and <br /> 3. ls impro��ed.installed or replaced b` the homeo���ner or licensed plumbing contractor. <br /> Skip ne�t 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 S <br /> (Permit Fc�es Continued On Nest Page) <br /> � <br />