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; � �, PLUMB�T����� a� .., . <br /> �"�:'�����3EING INSTALLED '' <br /> FIXTURE BSMT 1'� 2�' OTHER FIXTURE BSMT 1'� 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Cioset Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink � Water Heater <br /> Disposal 1 Water Softener <br /> l <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> PEI2MI"I'FEE CALCULATION(S) � �� <br /> BASED OFF — 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ 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 this applies; Cost of Permit $ l 5.00 <br /> State Surcharge $ .50 <br /> Mail-ln Fee(If Applicable) $ l.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />