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, <br /> . ��/,','�<:,� .- <br /> � PLUMBING FIXTURES BEING INSTALLED <br /> • FIXTURF, BSMT 1 2' OTHER FIXTURE BSMT 1 , / 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � j � Floor Drains � � <br /> I <br /> Lavatory � / i Sewer Ejector <br /> (� <br /> Bathtub o Laundry Tray � / <br /> Shower � Washer � / <br /> Kitchen Sink Water Heater <br /> � <br /> Disposal � Water Softener U <br /> Dishwasher Wet Bar ` <br /> � � <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> , BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following 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 tl�e fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />