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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT ls 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL 7'YPE FL FL <br /> Water Closet 3 Floor Drains <br /> Lavatory 4 Sewer Ejector <br /> Bathtub ,� Laundry Tray <br /> Shower ,� Washer <br /> Kitchen Sink Water FIeater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <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 fiature or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require moditication to electrical or gas service. <br /> 2. Has a total cost of$�00.00 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 neat secrion, 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 Nest Page) <br /> 2 <br />