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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 Floor Drains <br /> I 2 i t a o <br /> Lavatory Sewer Ejector <br /> � z Z a � � <br /> Bathroom Laundry Tray <br /> 1 2 I a o O <br /> Shower Washer <br /> 1 � i 1 0 0 <br /> Kitchen Sink Water Heater <br /> 1 1 1 � d <br /> Disposal Water Softener <br /> 0 o c � o 0 <br /> Dishwasher Wet Bar <br /> o � p p p a <br /> Sillcocks Miscellaneous <br /> 2 0 0 <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 eiectrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exciudine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or repiaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 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 />