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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 T 2ND OTHER FIXTURE BSMT 1 r 2"D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray � <br /> Shower Washer <br /> Kitchen Sink y' Water Heater <br /> /` <br /> Disposal x� Water Softener <br /> Dishwasher X Wet Bar <br /> Sillcocks Miscellaneous <br /> j <br /> I <br /> � � �� �� PERMIT FEE CALCULATIO�tT(S} � � <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or 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;excludinQ 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 $ .50 <br /> �� Mail-In Fee(]f Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> i <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />