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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 ,Z , � Floor llrains 3 <br /> Lavatory 3 t I' Sewer Ejector <br /> �� <br /> Bathtub � Laundry Tray ' � <br /> Shower Z � Washer 1 <br /> Kitchen Sink � � � Water Heater t <br /> Disposal Water Softener I <br /> Dishwasher Wet Bar � ' ' <br /> Sillcocks .Z Miscell�eous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE STATUE <br /> 0 Yes,this section applies <br /> The replacement of a Residential fixt�e or apnliance that meets all three of the following requirements: <br /> 1. s not require modif'ication to electrical or gas service. <br /> 2. Has a total cost of$500.00 ar less;ea�c ud' tl�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 S�charge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permft Fees Continued On Nezt Page) <br /> 2 <br />