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i � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURG BSM'I' 1'r 2�D OTHER FIXTURE BSMT I r 2�D OTHGR <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> S �`:� <br /> Lavatory � --, , Sewer Ejector <br /> y � ��, <br /> Bathtub ,� ,� Laundry Tray <br /> Shower Washer <br /> i ,? 1 1 <br /> Kitchen Sink � Water Heater <br /> Disposal � Water Softener <br /> Dishwasher I Wet Bar <br /> Sillcocks � Miscellaneous 1 <br /> t� <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this scction 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;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by thc homeowner or licensed contractor. <br /> Skip next section, if this applies; Cost of Permit S 15.00 <br /> State Surcharge � .50 <br /> Mail-In Fee(If Applicable) � 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />