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� . <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 /> B athtub Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscelianeous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <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 elech�ical or gas service. <br /> 2. Has a total cost of$500.00 or less; excluding the cost of the fixture or appliavice: 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-Iiz Fee(If Applicable) � 1.50 <br /> Total Permit F'ee a <br /> (Permit Fees Continued On Next Page) <br /> � <br /> - �_ <br />