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PLUMBING FIXTURES BE1NG INSTALLED <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT l T 2ND OT[-�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ` � Floor Drains <br /> � <br /> Lavatory i � Sewer Ejector <br /> [ <br /> Bathtub � Laundry Tray � <br /> Shower � Washer f <br /> l <br /> Kitchen Sink � Water Heater ' <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <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 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;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,ifthis applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />