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PLUMBING FIXTURES BEING 1NSTALLED <br /> FIXTURE BSMT 1' 2' OTHER FIXTliRE BSMT 1' 2'' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet . � Floor Drains <br /> Lavatory � � Sewer Ejector <br /> Bathtub Laundry Tray <br /> � ` <br /> Shower I Washer <br /> Kitchen Sink i Water Heater I <br /> Disposal , Water Softener <br /> Dishwasher Wet Bar <br /> � <br /> Sillcocks Miscellaneous <br /> � � PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATLTE � <br /> ❑ Yes, tbis section applies <br /> The replacement of a Residential fixture or appliance 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 or replaced by the homeowner or licensed con�actor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> � <br />