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A, <br /> t <br /> PLUMBiNG FIXTURES BEING INSTALLED <br /> F[XTURE BSMT lsr 2�'D OTHER FIXTURE BSMT ls' 2�'D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 3 Floor Drains 1 <br /> Lavatory 1 5 Sewer Ejector <br /> Bathroom 2 Laundry Tray � <br /> Shower � 1 Washer 1 <br /> Kitchen Sink 1 Water Heater 1 <br /> Disposal � Water Softener 1 <br /> Dishwasher 1 Wet Bar 1 <br /> Sillcocks 2 Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical 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 contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />