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. <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 L' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower � Washer I <br /> Kitchen Sink ( Water Heater <br /> Disposal � � Water Sofier.Pr <br /> Dishwasher ( Wet Bar <br /> Sillcocks Miscellaneous <br /> i <br /> i <br /> � � ��PERMIT FEE���CALCULATION(S)� � � + � <br /> �3ASED OFF - 2002 STATE S'TATUE <br /> ❑ Yes,this section applies <br /> The re lacement of only one Residential fixture or appliance that meets all three of the following <br /> P <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 /> �. Is improved, installed or replaceci by the homeowner or licensed plumbing car.tractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(lf Applicab(e) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />