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. <br /> <�' <br /> PLUMBING FIXTURES BEiNG INSTALLED ,' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT ls 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks . Miscellaneous <br /> . PERMIT FEE CALCULATION(S) ." � <br /> BASED OFF -2p02 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 /> 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. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Pemrit� $ 15.00 <br /> State Surcharge $ ''S.00 <br /> Mai1-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $�, c")� <br /> :r , <br /> (Permit Fees Continued OnNext Page) <br /> , <br /> 2 <br /> , , , <br />