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PLUMBiNG FIXTURES BEING INSTALLED <br /> F[XTURE BSMT 1 2N OTHER FIXTURE BSMT 1 2�D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 2 ,� 3 Floor Drains ,� <br /> Lavatory 2 ,� 5 Sewer Ejector <br /> Bathtub ,� Laundry Tray 1 <br /> Shower ,� 3 Washer <br /> Kitchen Sink ,� 2 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 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,instailed or replaced by ihe 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 Coatinued On Next Page) <br /> 2 <br />