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PLUMBING FIXT[_TRES BEING I�ISTALLED <br /> FIXTURE BSMT 1 2 OT'HER FIXT�JRE BSM'I' 1 2 OTHI:R <br /> TYPE FL FI, TYPE FL F�L <br /> Water Closei � ] � Floor Ihains % <br /> I <br /> Lavatory � � j� Sewer F,jector <br /> Bathtub � � Laundry "I'ray � <br /> Shower f ' W asher ! <br /> I <br /> Kitchen Sink i Water Heater � <br /> Disposal f Water Softener <br /> Dishwasher f Wet Bar � <br /> l <br /> Sillcocks � Miscellaneous <br /> � <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixtwe or appliance that meets all three of the following requirements: <br /> I. Does not require mai�cation to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluciin�the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if tt�is applies; Cost of PermiE $ I5.00 <br /> State Su�charge $ 50 <br /> Mail-In Fce(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />