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. � . , <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 T 2ND OTHER FIXTURE BSMT ls 2ND OTI-�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ( Floor Drains <br /> � <br /> Lavatory i Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher �bet Bar / <br /> � l��c... / <br /> Sillcocks Miscellaneous <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 a_p,pliance 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;excludin¢the cost of the fixture or appliance: and <br /> 3. 1s improved, installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip neact 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 />