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e <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 ST 2vv OTHI:R FIXTURE BSMT 1 sT 2"v OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � /J Floor Drains � <br /> C. <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower � W asher <br /> Kitchen Sink � Water Heater <br /> Disposal � Water Sofiener <br /> Dishwasher i Wet Bar <br /> I <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,tllis 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;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner ar licensed plumbi�g 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 />