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� <br /> PLUMBING FIXTURES BEING INSTALLED � <br /> FIXTUIZ� BSMT 1 2' OTHER FI�TURE BSMT 1' 2 OTHER <br /> TYPE PL FL TYPL FL I'L <br /> Water Closet I � Floor Drains � <br /> Lavatory � � Sewer Ejector <br /> Bathtub I Laundry Tray � <br /> Sliower �� Washer � <br /> ICitchen Sink � Water Heater <br /> � <br /> Disposal , Water Softener <br /> � <br /> Dishwasher i Wet Bar � <br /> Sillcocks � Miscellaneous <br /> PERNTIT FEE CALCULATION(S) <br /> BASED OFl� - 2002 STATE STATUE <br /> ❑ I'es, this section applies <br /> The replacement of a Residential fixture or ap�liance that n�eets all tlu�ee of'the following requirements: <br /> 1. Does not require n�odifcation to eleetrical or�as service. <br /> 2. Has a total cost of$�00.00 or less; eYcluding the cost of the fi�:ture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if diis applies; Cost of Pernut $ 15.00 <br /> State SLucharge S .50 <br /> Mail-In Fee (If Applicable) 5 1.50 <br /> 1'otal Pernut�ee � <br /> (�'ermit Fecs Continued On Next 3?age) <br /> � <br />