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11. <br /> , <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ` l 3 Floor Drains 1 3 <br /> Lavatory ; Sewer Ejector <br /> Bathtub Laundry Tray <br /> woixi <br /> Shower 1 Washer 1 J <br /> Kitchen Sink + Water Heater <br /> Disposal �y Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocksra Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF=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 />