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<br /> PLUMBING FIXTURES BEING INSTALLED
<br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
<br /> F' TYPE FL FL TYPE FL FL
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<br /> f� Water Closet � Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Baduoom Laundry Tray �
<br /> ` Shower � W asher /
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<br /> �• Kitchen Sink Z Water Heater
<br /> � Disposal ! Water Softener
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<br /> Disl�washer � Wet Bar
<br /> Sillcocks Miscellaneous _ I
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<br /> PERMIT FEE GALCULATION(S)
<br /> BASED QFF - 2002 STATE STATUE
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<br /> `' ❑ Yes,this secrion applies
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<br /> � The replacement of a Residential fixture or ap hp �ance that meets all three of the following requirements:
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<br /> � 1. Does not require modification to electrical or gas service.
<br /> �' 2. Has a total cost of$500.00 or less; excludine the cost of the fixture or appliance: and
<br /> ��' 3. Is improved, installed or replaced by the homeowner or licensed contractor.
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<br /> �' Skip next section,if this applies; Cost of Pernut $ 15.00
<br /> '� State Surcharge $ .50
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<br /> �t Mail-In Fee(If Applicable) $ 1.50
<br /> � Total Permit Fee $
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<br /> � (Permit Fees Continued On Next Page)
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