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' ' 1 , <br /> / <br /> �.y �, <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1sT 2'�v OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> iavaiory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink ter Heater � � <br /> Disposal Water ener <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 only 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 plumbin;contractor. <br /> Skip next section,if this applies; Cost of Permit $_ 15.00 <br /> State Surchar�e $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $��� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />