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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTUKE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � ) Floor Drains <br /> 1 <br /> Lavatory i � Sewer Ejector <br /> 1 <br /> Bathroom f ' Laundry Tray ' <br /> Shower I W asher � <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � �u�laneous i <br /> j�""(�1 %�� � <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. D e o require modification to electrical or gas service. <br /> 2. Has a t cos of$500.00 or less; x lu in the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> {Permit Fees Continued On Ne�Page) <br /> 2 <br />