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� <br /> PLUMBING FIXTURES BEING INSTALLED � <br /> � � <br /> FIXTURE BSMT 1 2' OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory ..L Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower � Washer <br /> Kitchen Sink � Water Heater <br /> Disposal ( Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> r"'L lC� �.0.Tc l� .^'I'L� �.�'"'�K '�. /�'{��1 5�.�4r�..� Cl�"r^��� T f��i"F�l3�J'yi <br /> �.�1C'fti r°J <br /> �;� ,_ ,� �� 'PERMIT�FEE�CALCULATION(S) � � � �� � <br /> ' BASED OFF - 2002 STATE STATLTE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tlu•ee 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;excludin�the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractar. <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 />