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I <br /> � <br /> � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE I'i BSMT IS 2 OTHER FIXTURE BSMT ls 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> i <br /> Water Clos' Floor Drains <br /> , <br /> Lavatory I' Sewer Ejector <br /> ; <br /> Bathtub I� Laundry Tray <br /> ,, <br /> I I <br /> Shower i� Washer <br /> �i i <br /> Kitchen Si ' Water Heater / <br /> Disposal i� Water Softener <br /> I <br /> Dishwasher{I Wet Bar <br /> li <br /> Sillcocks I i Miscellaneous <br /> �i <br /> i; <br /> I! <br /> �� <br /> li <br /> II <br /> �� <br /> j'' <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Y this section applies <br /> The replac II' ent of only one Residential fixture or appliance that meets all three of the following <br /> requiremen : <br /> 1. 'Does not require modification to electrical or gas service. <br /> 2. �',Has a totai cost of$SOOAO ar Iess;excludin the cost of the fixture oc appliance: and <br /> 3. I';Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip 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 $���iC� <br /> i. <br /> I��' <br /> (Permit Fe Continued On Next Page) <br /> 2 <br />