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, � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT � ZN� OTNER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub I l,aundry Tray <br /> Shower � W asher / <br /> Kitchen Siuk � Water Heater � <br /> Disposal ' Water Softener <br /> Dishwasher r Wet Bar I <br /> Sillcocks Miscellaneous <br /> �� �� � �� �� PERMIT FEE CA�,CULATION(S) � <br /> �� � BASED OFF - 2002 S'TATE STA7�'UE � � �� � <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 /> I. Does not require modification to electrical or gas service. <br /> ?. Has�toia! �ost of;5C0.�O or less;exc;ud;i�thc c��st of the fixt:are or ap�,liance:and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractur. <br /> Skip next section, if this applies; Cost of Permit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) � <br /> 2 I <br />