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w <br /> ' PLUMBING FIXTURES BEING INSTALLED <br /> , <br /> FIXTURE BSMT 1 2 OTHER FI�:TURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> _ Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower Washer <br /> � <br /> Kitchen Sinl: � Water Heater <br /> Disposal Water Softener <br /> Dishwasher t Wet Bar <br /> Sillcocks � Miscellaneous <br /> - ___-- - <br /> �� PERMT�T 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; 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 Permit $ 15.00 <br /> State Surchar�e $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> � <br />