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� <br /> � , !'` <br /> PLUMBING FIXTURES 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 Sewer Ejector <br /> Bathtub �� Laundry Tray <br /> Shower j'°� Washer <br /> `v <br /> Kitchen Sink Water Heater <br /> F, ; <br /> Disposal ;--� Water Softener <br /> Dishwasher �`;, Wet Bar <br /> Sillcocks Miscellaneous <br /> PEP.I`✓II'i' FEE Ct�LCULATIrJT:(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> Th replac ent 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) $ 1.50 <br /> Total Pernut Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />