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PLUMBING FIXT'URES BEiNG INSTALLED <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray Q <br /> /` <br /> Shower Washer <br /> Kitchen Sink Water Heater j <br /> r <br /> v�spo� w�sot�� <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> FERAiIIT FEE GALCULATI4N(S) <br /> BASET�(?�F-2Q02 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixtare or appliance that meets all three of t.�e following <br /> requirements: <br /> 1. Does not require modificadon to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fiact�re or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15•00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Totai Permft Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />