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E � <br /> r <br /> PLi'IM�ING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Wa��' <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> P RMIT`FEE CALCULATiON(S) , <br /> B SED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only obe 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;excluding the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or liceiised plumbing contractor. <br /> Skip ne�section,if this applies; Cost of Pemut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> , <br /> , Total Permit Fee `$� <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />