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� + f <br /> , R , <br /> ♦� , . <br /> ° PLUMBING FIXTLTRES BEING IN�TALLED <br /> FIXTURE BSMT 1 2 OTHER FI�TURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> �Vater Closet � I Floor Drains <br /> Lavatory � r Sewer Ejector <br /> Bathiub � Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <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 tluee of the following requuements: <br /> 1. Does not require modification to elech•ical or gas seivice. <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 /> Slcip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surchar�e $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit F'ee $ <br /> (Permit�'ees Continued On l�ext Page) <br /> � <br />