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� <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 ' 3 Floor Drains I <br /> Lavatory ( � Sewer Ejector <br /> Bathr� 1 Laundry Tray 1 <br /> Shower Washer <br /> � � <br /> Kitchen Sink ' Water Heater 1 <br /> Disposal I Water Softener <br /> Dishwasher I Wet Bar ' ' <br /> Sillcocks � Miscellaneous � <br /> SQC'on�lp��.1.tl� � <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The rep(acement of a Residential fixture or aQpliance 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 Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />