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PLUMBING FIXTURES BEING iNSTALLED <br /> FIXTURE BSMT 1 T 2�' OTHER FIXTURE BSMT 1 T 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet % Floor Drains <br /> Lavatory /� Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower 1 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 ar 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;excludi.n�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 $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />