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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1S1 2"D OTHER FIXTURE BSMT 1'' 2"D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains �/� <br /> �� <br /> Lavatory •\/ Sewer Ejector <br /> � <br /> Bathtub Laundry Tray ,� <br /> Shower � Washer �� <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener x <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous � � �Yldfl� <br /> 8o�uner�- �C <br /> �� <br /> �� <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> � �, <br /> The replacement�.f only one Residential fixture ar appliance that meets all t e of the following <br /> requirements: � <br /> 1. Does not require odification to electrical or gas service. � '�� <br /> 2. Has a total cost o����0.00 or less; excludine the cost of the fixture or app�ar�ce: and <br /> 3. Is improved,it�stalled or replaced by the homeowner or licensed plumbj�ig contractor. <br /> Skip next5ection,if this applies; � Cost of Permit �;�°� $ 15.04 <br /> � �State Surcharge � $ 1.00 <br /> � Mai1=�.Fee(If App 'able) $ 2.00 <br /> Total Permit Fe� $ <br /> � <br /> J <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />