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3 <br /> PLUMBING FIXTURES BCING 1NSTALLED <br /> F1�TURE ' BSMT 1' 2' OTHER FI�TLRE BSMT 1' 2' 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 /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � <br /> � PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATLTE <br /> ❑ Yes, this section applies <br /> The replacement of only one Residential fixture ar appliance that meets all three of the following <br /> 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 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 />