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PLUMBINC FIXTURES BEING INSTALLED <br /> FIXTURE BSMT �sT 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL T'YPE FL FL <br /> Water Closet � � Floor Drains � <br /> Lavatory � 2 Sewer Ejector <br /> �.7 <br /> Bathtub � I Laundry Tray I <br /> Shower Washer ' <br /> Kitchen Sink � Water Heater I <br /> Disposal I Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks c� 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 or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved, installed ar replaced by the homeowner or licensed 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 F'ees Continued On Next Page) <br /> 2 <br />