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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1'T 2 ° OTHER FIXTURE BSMT 1 T 2N OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet `�' • Floor Drains <br /> �- <br /> Lavatory � (; i [,,.I Sewer Ejector <br /> Bathtub � � Laundry Tray <br /> Shower `' Washer � <br /> � L-- <br /> Kitchen Sink Water Heater <br /> Disposal i Water Softener I <br /> � <br /> Dishwasher Wet Bar <br /> Sillcocks •� Miscellaneous <br /> y <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;excluding 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(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />