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< < <br /> t � <br /> 'v';:'.;,. ^�.` PLUIVIBING FI�TURES BEING:INSTALI:ED �'K,��`;x.x� h�?�;. '.... ', ,', <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer E}ector <br /> Bathtub Laundry°fray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> r <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) : <br /> � BASED OFF -2002 STATE STATUE �Y '° <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;excludine the cost of the fixture or appliance: and <br /> 3. ]s improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if this appiies, Cost of Permit $ 15.00 <br /> . State Surcharge $ 5.00 <br /> � Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee � $�— <br /> � <br /> y <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />