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PLLTMBING FIXTURES BE1NG INSTALLED <br /> FIXTURE BSMT 1 � 2�D OTHER FIXTURE BSMT 1'� 2"u OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ' Floor Drains <br /> Lavatory ', Sewer Ejector <br /> Bathtub ', Laundry Tray <br /> Shower ', Washer <br /> Kitchen Sink ' Water Heater <br /> � <br /> Disposal I Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks ' Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2a02 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 /> 1. Does not require modification to electXical 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 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 />