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1 <br /> � <br /> . <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT I 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � l � Floor Drains � I _ b��uye <br /> Lavatory � 1 � Sewer Ejector <br /> 1 <br /> Bathtub { 4 Laundry Tray � <br /> t <br /> Shower I Washer I <br /> Kitchen Sink � Water Heater � <br /> Disposal { Water Softener <br /> l <br /> Dishwasher � Wet Bar + <br /> l <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes, this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excluding the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner ar licensed plumbing contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />