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, ' <br /> PLUMBING FIXTURES BE[NG INSTALLED <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains � <br /> � �.. <br /> Lavatory ; / Sewer Ejector <br /> �7` <br /> Bathtub � � Laundry Tray / <br /> �. \ <br /> Shower � W asher <br /> Kitchen Sink f Water Heater <br /> I <br /> Disposal ( Water Softener <br /> Dishwasher ` Wet Bar <br /> Sillcocks � Miscelianeous <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 /> I. Does not require modification to electrical or gas service. <br /> 2. Nas a total cost of$500.00 or less;exdudin�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 />