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� PLUMBINGFIXTURES BEING INSTALLED <br /> FIXTURE � BSMT 1 2� I OTHER FIXTURE BSMT � 1'' 2� � OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains � <br /> Lavatory � � � Sewer Ejector <br /> Bathtub � 3 Laundry Tray � � / <br /> , <br /> Shower � W asher 1 I <br /> l � <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener � <br /> Dishwasher � Wet Bar � <br /> Sillcocks � Miscellaneous � <br /> � � <br /> T,e�-�- v��.; <br /> � � �� PERMIT �EE��CALCULATION(S) � <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ 1'es,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 appiiance: 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 />