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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I 2 Floor Drains I <br /> Lavatory Sewer Ejector <br /> Bathceo ir+47 ^ 3 Laundry Tray I <br /> Shower p I Washer I I <br /> Kitchen Sink Water Heater <br /> Disposal I Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> Via% aw _. ._-4.-s.mir-M9. - r. • IVAP.? D W <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 /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or Iicensed 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 />