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# <br /> . � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIX'IURE BSMT 1 2 OTHER FIXTURE BSMT 1 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ; ` � Floor Drains � �� <br /> � � <br /> Lavatory I S Sewer Ejector <br /> Bathtub Laundry Tray I <br /> ,� � f �?caruyt <br /> U <br /> Shower � � Washer 1 <br /> 1 <br /> Kitchen Sink � Water Heater � <br /> Disposal I Water Softener ' <br /> Dishwasher Wet Bar <br /> � <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes, this section applies <br /> The replacement of only one Residential fixture or aQpliance 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; excludine 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 $ I 5.00 <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 />