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, - • � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT I' 2 OTHER FIXTURE BSMT i' 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> _ _ _ <br /> Water Cioset 2 3 3 Fioor Drains � 1 4 <br /> Lavatory � 4 3 Sewer Ejector <br /> - _ ___- -- <br /> Bathtub � Laundry Tray � 1 1 1 <br /> St�ower � � 3 VJasher � <br /> Kitchen Sink 3 Water Heater <br /> Disposal � � Water Softener <br /> Dishwasher 2 Wet Bar ,� <br /> Sillcocks 4 Miscelianeous � <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> Th�replxcem€nt of a I�esid�ntia7 fxiure or appliart�€that m�ts all tl�r�€of the folk>tiving requirem�nts: <br /> 1. Dces 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. ts imprvved,insEallecf or replaced by the homeowner or licensed contraetor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On lYext Page} <br /> 2 <br />