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� PLUMBING FI�TURES BEING INS T�LLED� � � � � <br /> FIXTURE BSMT 1'� 2'�D OTHER FIXTURE BSMT ls� 2�D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory I Sewer Ejector <br /> Bathtub ( Laundry Tray <br /> Shower 1 Washer <br /> 1 <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT �EE�C�.I,CULATION(S) <br /> BASED OFF - 2002 STA"I'E STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance tl�at 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; excludin�the cost of the fixture or appliance: and <br /> 3. ls 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 /> Totai Permit Fee � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />