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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT (sr 2ND OT`HER FIXTURE BSMT 1S'1' 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � I � Floor Drains <br /> Lavatory ( i Sewer Ejector <br /> t <br /> Bathtub Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher Wet Bar <br /> Sil lcocks M iscellaneous 2 1 c� <br /> � v I I�U,Y1 A, �l-� <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 $ I 5.00 <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 />