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PLUMBING FIXTURES BEING INSTALLED �J <br /> PIXTURE BSMT 1ST Z1D OTHER FIXTURE BSMT 1'� 2�D OTHER ---- <br /> TYPE FL PL TYPE TL PL '_ <br /> Water Closet Floor Drains <br /> Lavatory Scwcr Ejcctor <br /> Bathtub Laundry Tray <br /> Showcr Washer <br /> Kitchen Sink Watcr Heater <br /> l <br /> Dis�osal Watcr Softencr <br /> Dishwasher Wct Bar <br /> Sillcocks Miscellancous <br /> PERMIT FEE CALCULATION(S) <br /> BASCD OFF - 2002 STATE STATUE <br /> ❑ Yes',this scction applics <br /> The replacement of only one Residential fiixWre or ap�liance that meets all three of the followin� <br /> requircments: <br /> 1. Docs not requirc modification to electrical or gas servicc. <br /> 2 Has a total cost of$500.00 or less;excludin�,�he cost of the fixture or appliance: and <br /> 3. ]s improved, installed or rcpl�ced by thc homeowaer or licensed plumbing conU�actor. <br /> Sl:ip next section, if this applies, Cost of Permit � I�.00 <br /> State Surchar�c S �.00 <br /> Mail-In Pcc(If Applic.�blc) $ 2.00 <br /> '1'otal Yermit I�ee � <br /> (Perrnit Fees Continucd On Next Page) �--�- <br /> 2 <br />