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�� � <br /> � <br /> \ <br /> PLUMBING FIXTIJRES BEING INSTALLED <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 I � Sewer Ejector <br /> Bathtub 3 Laundry Tray � <br /> Shower % Washer <br /> Kitchen Sink 2 Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher r Wet Bar / i <br /> Sillcocks � Miscellaneous <br /> � PERMIT FEE CALCUL�ATION(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; 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />