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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT l� � 2'�D O"I'HER FIXTURE BSMT l�� ��D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � � Floor Drains � <br /> Lavatoiy � Sewer Ejector i <br /> ! 3 <br /> Qathtub � Laundry Tray I / <br /> ( <br /> Shower I r Washcr / <br /> l ! <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher f Wet Bar ) <br /> l � <br /> Sillcocks � Miscellaneous <br /> PERMIT FLL CALCULAT[ON(S) <br /> BASED OFF - 2002 STATE S"l'A"I�UE <br /> � Yes,this section applies <br /> I�he replacement of a Residential fixture or a�pliance that meets all three of the following requirements: <br /> I. Does not require�nodification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excludin�the cost of the tixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed conU�actor. <br /> Skip next section, if this applies; Cost of Permit $ I5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Nermit Fees Continued On Next Page) <br /> 2 <br />