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� <br /> t <br /> `PLUMBING FIXTIJRES BElNG II�TSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet - � Floor Drains <br /> / .:�. <br /> Lavatory ; _� �/ Sewer Ejector <br /> �� / <br /> Bathtub � / Laundry Tray / <br /> / <br /> Shower 1 � i Washer J <br /> / <br /> Kitchen Sink � Water Heater <br /> Disposal / Water Softener <br /> Dishwasher } Wet Bar / <br /> / <br /> Sillcocks � Miscellaneous <br /> PERMIT FE.E CALCULATION(S) <br /> "�� BASED OFF -2002 STATE'STATLTE '` :' � � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requu•ements: <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 section, if this applies; Cost of Permit $ 15.00 <br /> State Suscharge � .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee � <br /> (Permit Fees Continued On Nest Page) <br /> 2 <br />