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.� <br /> � <br /> �, ' <br /> r <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1'T 2�D OTHER FIXTURE BSMT 1'� 2'�D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet -� Floor Drains � <br /> � _� <br /> Lavatory � Sewer Ejector <br /> � � <br /> Bathtub f� Laundry Tray <br /> .� � <br /> Shower ` ( Washer ( <br /> I <br /> Kitchen Sink � Water Heater � <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar � <br /> Sillcocks -� Miscellaneous <br /> � <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;excludinQ 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 Permit $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />