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� <br /> PLUMBING FIXTLTRES BEING INSTALLED � <br /> FIXTURE BSMT 1 2� OTHER FIhTURE BSMT 1' 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> PER�!I1T FEE CALCULATION(S) ' <br /> � � � � BASED OFF - 2002 STATE STATUE � �� �� <br /> ❑ Yes,this section applies , <br /> The replacement of only one Residenrial 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; excludine the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section, if this applies; Cost of Pernut $ 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 />