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, <br /> � <br /> � PLUMBING FIXTURES BElNG INSTALLED <br /> FIXTURE BSMT 1' 2'� OTHER FIXTURE �� BSMT ' 1 2 � OTHER � <br /> TYPE FL FL TYPE FL FL <br /> Water Closet (�� � 3 Floor Drains � <br /> IS.� <br /> Lavatory �� ' � SewerEjector <br /> Bathtub � Laundry Tray �� f <br /> Shower �`^ � Washer �� I <br /> +- <br /> Kitchen Sink � Water Heater � 4�-t,�;� <br /> r <br /> Disposal ' Water Softener <br /> � 0}�`er� <br /> Dishwasher ' Wet Bar p� <br /> r� <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> I BASED OFF - 2002 STATE STATUE � <br /> ❑ Yes, this section 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 the homeowner or licensed contractor. <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 Next Page) <br /> 2 <br />