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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 ZND OTHER FIXTURE BSMT 1 T ZND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet / Floor Drains <br /> Lavatory / Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower % 4 S+ Washer <br /> J� f kc' <br /> Kitchen Sink � Water Heater <br /> Disposal 1 Water Softener <br /> Dishwasher ✓ Wet Bar <br /> � <br /> Sillcocks Z Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Ycs,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l. Does aot 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. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ I5.00 <br /> State Surchargc $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />