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.. ' PLtT1VIBING:FIXTLTRES BEING';IN'STALLED a;�� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I � � Floor Drains <br /> Lavatory ' ' � Sewer Ejector <br /> Bathtub Z Laundry Tray � <br /> Shower , Washer � <br /> Kitchen Sink � Water Heater ' <br /> Disposal ' Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks �,,,f Miscellaneous <br /> � <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 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;excludinQ the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next secrion,if this applies; Cost of Pernrit $ 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 />