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PLUMBING FIXTURES BE1NG INSTALLED <br /> FIX'I`URE BSM'T ls 2�'r' OTHER FIXTURE BSMT 1 I 2`" OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower / Washer <br /> Kitchen Sink Water Heater <br /> � <br /> Disposal / Water Softener <br /> Dishwasher � Wet Bar ii <br /> Sillcocks Miscellaneous <br /> PERMTT 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;excludin�the cost of the fixture or appliance: a�d <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractbr. <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 /> I I <br /> 2 <br />