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�� , �s <br /> PLUMBING FIXTURES BEING 1NSTALLED , <br /> FIXTURE BSMT 1' 2' OTHER FIXTURE BSMT 1 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> .Z <br /> Lavatory � Sewer Ejector <br /> Bathtub ( Laundry Tray <br /> Shower ' Washer <br /> Kitchen Sink � Water Heater <br /> Disposal i Water Softener ` <br /> Dishwasher ` Wet Bar <br /> Sillcocks Miscellaneous <br /> �� 1 l�IMS /� � I�f� � �-I��-�6'��N.1 C� V�t �-�l� <br /> PERMIT FEE CALCULATION(S) �� <br /> BASED OFF - 2002 STATE STATUE <br /> � Yes,this section applies <br /> The replacement of a Residentia] fixture or a� liance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. ?-Ias z tota]cost of�,500.00 cr less, exc?udin�the c�,st;�f il;c fi,.ture or appiiznce: ar.d <br /> 3. Is improved,installed or replaced by the homeowner ar licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ ��j, S'Q <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />