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PLUMBINGFIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE 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 /> � <br /> Shower ' Washer <br /> Kitchen Sink Water Heater � <br /> � <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 a Residential fixture or ap�liance that meets all tlu�ee of the following requirements: <br /> 1. Does not require modification to elecn�ical or gas seivice. <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 Surcharae $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) � <br /> 2 <br />