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� <br /> . , <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT I 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 W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �J�l'12 C�� ��UL ��J c:-� T U ( f�i—� � /`�', ('/J��,l'9�l� <br /> �� <br /> �, PERMIT FEE CALCULATION(S) '�� <br /> �, BASED OFF - 2002�STATE STATUE � �� � <br /> ❑ Yes; this section applies <br /> The replacement of a Residential fixture or apvliance that meets all three of the following requirements: <br /> 1. Does not require mod�cation 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />