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• �/ <br /> , <br /> � PLUMBING FIXTURES BEING 1NSTALLED <br /> FI�TUItE BSMT 1' 2 OTH�R FIXTURE BSMT 1' 2� OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � j � Floor Drains � <br /> ! <br /> Lavatory � � � Sewer Ejector <br /> Bathtub / Laundry Tray � <br /> Shower � Washer / <br /> Kitcl�en Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher / Wet Bar <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes, this section applies <br /> The replacement of onl��one Residential fixture or appliance that meets all three of the foilowing <br /> requirements: <br /> 1. Does not requit�e modification to electrical ar gas service. <br /> 2. Has a total cost of$500.00 or less; excludin� the cost of the fixture ar 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 />