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' UMBI.NG FTU ES BEING INSTAILL <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 33 32 Floor Drains 6 <br /> Lavatory 33 32 Sewer Ejector <br /> Bathtub 1 Laundry Tray 1 <br /> Shower 31 31 Washer 3 <br /> Kitchen Sink 34 32 Water Heater 2 <br /> Disposal Water Softener 1 <br /> Dishwasher Wet Bar <br /> Sillcocks 4 Miscellaneous 5 <br /> PERMITI?EE ALCULATION(S) • <br /> BASEIOF-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;excluding 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,if this 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 />