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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE j BSMT 1st OM1' OTHER FLXTURE BSMT I5T 2'° OTHER <br /> TYPE j FL FL TYPE FL FL <br /> 1 <br /> jWater Closet 2 Floor Drains <br /> 2. <br /> Lavatory Ejector <br /> Bathtub Laundry Tray 1 <br /> Shower Washer <br /> Kitchen Sink ' Water Heater <br /> Disposal Water Softener <br /> I Dishwasher Wet Bar <br /> Sillcocks 1 Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes.this section applies <br /> The replacement ut only one Residential fixture or appliance that meets all three of the following <br /> requirements. <br /> I Does not require modification to electrical or gas service. <br /> 2. Has a total cost of 5500.00 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 S 15.00 <br /> State Surcharge S I.00 <br /> Mail-In Fee ill Applicable' S 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On\ext Page) <br />