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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSM1' I � 2ND O"I'HER FIXTURE BSMT 1 ' 2"D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub I Laundry Tray <br /> Shower � Washer <br /> Kitchen Sink ( Water Heater <br /> Disposal � Water Softener <br /> Dishwasher I 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 appliance 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;excludine the cost of the fixture 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(Ifi Applicable) $ 2.00 <br /> Total Permit Fee � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />