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PLI7MBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT ls 2�' OTT�R FIXTCJRE BSMT ls� 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � . Floor Drains <br /> Lavatory ' /^ Sewer Ejector <br /> Bathtub Laundry Tray � <br /> Shower 1 Washer , <br /> 0� <br /> Kitchen Sink ` Water Hea,ter I <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 only one Residential fixture or a�piiance 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;excludin�the cost of the�acture 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />