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. <br />, • <br /> I <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT l r 2` OTHER FIXTURE BSMT 1' 2 OTHER <br /> TYPE FL FL ��� TYPE FL FL �� <br /> � � <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 /> I <br /> PERMIT FEE CALCULATION(S) � <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or ap,�liance 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;excludinQ the cost of the fixture or appl�ance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this appties; Cost of Permit $ ]5.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) � $ 2.00 <br /> Total Permit Fee $ <br /> I <br /> x P <br /> (Perm�t Fees Cont�nued On Ne t age) <br /> i � <br /> 2 <br /> i <br />