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PI IUMBiNG F IXTURES BEING INSTALLED <br /> FIXTURE BSMT ls 2' ° OTHER FIXTURE BSMT 1ST 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 � u'ater�ofter;er I <br /> Dishwasher Wet Bar <br /> Sillcocks i Miscellaneous <br /> i PERMIT FEE CALCULATION(S) <br /> � BASED OFF - 2002 STATE STATUE <br /> � Yes,this section applies <br /> The replacement of only une Residential fixture or appliance 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$SOO.t)U or less;excludine the cost of the fixture or appliance:and <br /> 3. is i�ilpt-c�ve.�,<nstal.icd or reptaced'o�ihe homeowraer or litiensed plumbing co;itract�r. <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 $���0 <br /> (Permit Fees Continaed On Next Page) <br /> 2 <br />