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PLUMBING FIXTURES BEING 1NSTALLED <br /> FIXTURE BSMT 1 2' OTHER FIXTURE BSMT l 2��� OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � � Floor Drains <br /> Lavatory � � Sewer Ejector <br /> Bathtub Laundry Tray i <br /> Shower � / Washer � <br /> ( <br /> Kitchen Sink � � Water Heater � <br /> Disposa] � Water Softener � <br /> Dishwasher � Wet Bar <br /> Sillcocks r� Miscellaneous <br /> ,L <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; excludinQ 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) $ Z.00 � <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />