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` PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 J � Floor Drains 1 <br /> � � <br /> Lavatory j I � Sewer Ejector <br /> Bathtub 1 � Laundry Tray I � <br /> Shower /� W asher <br /> ar• ► I <br /> Kitchen Sink � Water Heater � <br /> Disposal Water Softener <br /> � <br /> Dishwasher j 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 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 contractor. <br /> Skip next section, if this applies; Cost of Pernut $ 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 />