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� <br /> � ��.�������„ ���„�' ����PLUMBING FIXTURES B�, � '� �.,��s��`��"���"��:` �.:s� '��.� <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 I Laundry Tray � <br /> Shower � Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneou <br /> • �Q.� . � �- <br /> PERMTT FEE CALCULATION(S) <br /> BASED OFF — 2002 STATE STATUE � <br /> ❑ Yes, this secrion applies <br /> The replacement of a Residential fixture or ap lp iance 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 Pernut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />