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� "'� PLUNIBING FIXTURES BElNG Il�TSTALLED j <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 Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATtTE <br /> ❑ Yes, this section applies <br /> The replacement of a Residential fixture or a� lip ance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2 Has a total cast of$SOO.CO or less; excludin�the cost of the fixture or appliance: ar.d <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) $_�2.,J00 <br /> Total Permit Fee $�� <br /> � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />