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♦► <br /> � � � PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 � 2' ' OTHER � FIXTURE BSMT 1' 2� OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet t I z Floor Drains � g <br /> ✓ � <br /> Lavatory � ( � � Sewer Ejector <br /> Bathtub � Laundry Tray i � <br /> I <br /> Shower ,-L Washer l <br /> �' <br /> Kitchen Sink � Water Heater <br /> Disposal I Water Softener <br /> Dishwasher Wet Bar ( � <br /> Sillcocks � Miscellaneous <br /> ��, PERMIT FEE CALCULATION(S) -� <br /> � BASED OFF - 2002 STATE STATUE � <br /> � . <br /> ❑ 1 es, this section applies <br /> The replacement of onl}�one 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$500.00 or less; excludin�the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Sldp 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 $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />