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1 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT I�� 2�D OTHER FI?�TURE BSMT I� � ��D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet '� Floor Drains ' i <br /> f� <br /> Lavatory � � Sewer Ejector <br /> Bathtub .� Laundry Tray ' <br /> Shower ( W asher � <br /> Kitchen Sink � Water Heater ( <br /> Disposal ( Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks � Miscellaneous <br /> � PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 S'T'ATE STATUE <br /> � Yes,this section applies <br /> The replacement of only one Residential fixture or a�pliance 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;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 $ I5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Ncxt Page) <br /> 2 <br />