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. <br /> PLUMBING FIXTURES BEING INSTALLED '� <br /> FI7�TURE � BSMT � 1' ' 2� �� OTHER FIXTURE � BSMT 1'' 2'� OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ' i � Floar Drains <br /> 1 <br /> Lavatory � � �y Sewer Ejector <br /> _� <br /> Bathtub / Laundry Tray � <br /> Shower ` Washer i <br /> 6 <br /> Kitchen Sirilc Water Heater <br /> i <br /> Disposal Water Softener <br /> Dishwasher ' Wet Bar � <br /> Sillcocks Miscellaneous <br /> � PERMIT FEE CALCULATION(S) � � <br /> � � BASED OFF - 2002 STATE STATUE� j <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture ar 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; excludin�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 $ ,Sp <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> � <br />