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PLUMBING FIXTURES BEINC'�INSTALLED <br /> FIXTURE BSMT I� � 2ND OTHER FIXTURE E3SMT l�� 2"D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF- 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or ap�liance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical ar gas service. <br /> 2. Has a to1a1 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 contractor. <br /> Skip next section, if this applies; Cost of Permit S 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On NexY Page) <br /> 2 <br />