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8/26/2014 7: 56 AM FROM: 9524914307 T0: 9522494616 P. 2 <br /> PLUMBING FIXTURE5 BEING INSTALLED <br /> FIXTURE BSMT 1'� 2ND OTHER FIXTURG BSMT I' 2`� OTI-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor brains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink 1 Water Heater <br /> Disposal Water Softener <br /> Disnwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> move dr in ines <br /> PERM.IT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE STATLIE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential tixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not rcquire moditication to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exchidin�the cos�of the tixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Pennit $ I 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(1f Applicablc} $ 2.00 <br /> Total Permit Fee S+ <br /> (Permit Fees Continued On Next Pagej <br /> 2 <br />