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PLUMBING FIXTUR.ES BEIlVG INSTALLED <br /> F[XTURE BSMT 1 S 2' ' OTHER FIXTURE BSMT 1 s 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Claset I �i Floar Drains <br /> 1 <br /> Lavatory I( I Sewer Ejector <br /> I <br /> Bathtub Laund�y Tray <br /> Show�er 11{�asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Disliwasher t�et Bar <br /> Sillcocks ,Mis�l�neous � <br /> ��� <br /> , c��i u� <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only oee Rcsidenteal fixttzre or appliance that meets a!I three of the following <br /> requirements: <br /> l. Does not require modification to electricat or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine 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 Pennit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> • Total Permit Fee $ <br /> (Permit Fees Continued Oo Next Page) <br /> 2 <br />