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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 ' � Floor Drains 1 I �,Qqo <br /> � d'� <br /> Lavatory 1 � Sewer Ejector <br /> Bathroom 1 1 � Laundry Tray <br /> Shower ' I Washer I <br /> Kitchen Sink 1 Water Heater ' <br /> Disposal ` 1 Water Softener <br /> 1 <br /> Dishwasher t Wet Bar 1 <br /> � <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULAT'TflN(Sj ; <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. Does 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 licsaseu�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 Next Page) <br /> 2 <br />