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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT isT 2�D OTHER FIXTURE BSMT lsT ��D OTHER � <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 3 3 1 Floor Drains 4 6 <br /> Lavatory � 4 1 Sewer Ejector <br /> $athrovrrr 1 Laundry Tray 2 � <br /> 'r�Tl� <br /> Shower 3 � 1 Washer Z <br /> Kitchen Sink � Water Heater <br /> Disposal 1 Water Softener � <br /> Dishwasher 1 Wet Bar 3 <br /> Sillcocks 3 Miscellaneous 2 <br /> PERMIT FEE CALCULATION(S) <br /> 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 /> I. Does not require moditication to electrical or gas service. <br /> ?. 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 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) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />