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: <br /> PLUMBiNG FIXTURES BEING 1AiSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTE�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Fioor Urains <br /> Lavatory Sewer Ejector <br /> Bathtub [.aundry 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-2002 STATE STATUE <br /> � Yes,this section applies <br /> T'he replacement of only one Residential fiacture or appliance that meets all three of the following <br /> requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$SOO.QO or.less;excludin¢the cost of the fixture or appliance:and <br /> 3. Is improve�,installed or replaced by the homeowne.�or licensed plumbing contractor. <br /> Skip next secUion,if this applies; Cost of Permit � I S.OU <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Tof�l Permit Fee a ci� <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />