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! <br /> � PLUMBING FIXTURES BEING INSTALLED � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2N OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I � � Floor Drains � � � <br /> Lavatory � I ' L Sewer Ejector <br /> �7 <br /> Bathtub I 2 Laundry Tray I � <br /> .� <br /> Shower I Washer I ' <br /> Kitchen Sink ' Water Heater ' <br /> Disposal I Water Softener <br /> Dishwasher I 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 a Residential fixture or a�pliance that meets all three of the following requirements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a total cost of�500.00 or less;excludine 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />