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1"41 AffitV <br /> 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 7 Floor Drains 5 <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> IAA, St vik <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> eYetcAltS <br /> �✓+/ld( 4143.1% Fa Le.v14-cv.+" <br /> PERMIT FEE CALCULATION(S) ` <br /> BASED OFF-2002 STATE STATUE <br /> 0 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;excluding 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) $ 2.0.0 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />