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1 . <br /> , <br /> PLUMBING FIXTURES BE1NG INSTALLED ,P: , , ._- _ <br /> FIXTURE BSMT 1 T 2'JD OTHER FIXTURE BSMT 1 2 OTHER <br /> TypE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener l <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � �� PERM[T FEE CALCULATION(S) � � � � � � � <br /> BASED OFr -2002 STATE STATUE <br /> [V� 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 Surcharge $ .50 <br /> � Mail-In Fee(If Applicable) $ L50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />