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� <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FI�TURE BSMT 1 2 ' OTHER FIXTURE BSMT 1 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I � � Floor Drains i <br /> 1 <br /> Lavatory J � �, Sewer Ejector <br /> Bathtub Z Laundry Tray � <br /> Shower � � Washer � <br /> Kitchen Sink � Water Heater i <br /> J <br /> Disposal ` � Water Softener <br /> 1 <br /> Dishwasher ' Wet Bar <br /> Sillcocks � Miscellaneous <br /> ;i%i <br /> � <br /> PE�Z'l�IT FEE C�I,CULATIJTT(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixiure or�pliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas seivice. <br /> 2. Has a total cost of$500.00 or less; excludine the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner ar licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee (If Applicable) $ 1.50 <br /> Total Pernut Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />