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� <br /> � <br /> -.� PLUM�INCs FIXTURES:BEING INSTAL�ED � <br /> FIXTURE BSMT l 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathroom � Laundry Tray I <br /> Shower I Washer I <br /> Kitchen Sink � Water Heater I <br /> � <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> � k �a��ERM�TdF�ECALCULATION(S) �w, , <br /> � r �, n�.� ,, � � �;_ �p f < <br /> ;�; � . ,,f=.; �.BAS�ED`:O��..2002 �TAZ'E ST�TIJE .. : � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or apnliance that meets all three of the following reyuirements: <br /> ]. 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 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 />