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PLUMBING FIXTU�ES BEING 1NSTALLED <br /> FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ,� 2 Floor Drains <br /> Lavatory � 3 Sewer Ejector <br /> Bathtub � � Laundry Tray ,� <br /> Shower Washer ,� <br /> Kitchen Sink ,� Water Heater ,� <br /> Disposal ,� Water Softener <br /> Dishwasher ,� Wet Baz <br /> Sillcocks Miscellaneous <br /> PERMIT FEE ALCULATION(S) <br /> BASED OFF -2 2 STATE 5TATUE <br /> ❑ Yes,this section applies <br /> The replacement of onty one Residential fiarture or appliance that meets all three of the following <br /> requirements: <br /> 1. Dces 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 or 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 Neat Page) <br /> 2 <br />