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PLUMBING FIXTURES BE1NG INSTALLED <br /> FI\il_Rl-: BS�1T I� 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> �'ater Closet Floor Drains <br /> Lavaton Sewer Ejector <br /> Bathtub ` Laundry Tray <br /> 1 � <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> 9 <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 only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> I. Does not require modification to electrical or gas service. <br /> 3. Has a total cost oi$�OO.OG or less;excludin�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 $ 5.00 <br /> Mail-InFee(IfApplicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On \ext Page) <br /> 2 <br />