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� � , ,� <br /> � <br /> PLUMBING FIXTURES BElNG INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 3 a Floor Drains ' <br /> Lavatory � ,3 Sewer Ejector <br /> Bathtub � t Laundry Tray � <br /> Shower � 1 Washer � <br /> Ki�chen Sijk � I Water Heater � <br /> � <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar � + <br /> � <br /> Sillcocks � Miscellaneous <br /> ; PERMIT FEE CALCULATION(S) � � <br /> BASED OFF - 2002 STATE STATLTE � <br /> ❑ Yes,this secrion 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 licensed contractor. <br /> Skip next section,if this applies; Cost of Pernut $ 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 />