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� <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2' OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL ���L�j <br /> Water Closet / � � Floor Drains � � <br /> Lavatory / � � Se«�er Ejector <br /> Bathtub I 1 Laundry Tray � <br /> Shower � / � Washer � <br /> Kitchen Sink / 1 Water Heater f <br /> ( <br /> Disposal / 1 Water Softener / <br /> 6 � <br /> Dishwasher l 1 Wet Bar <br /> Sillcocks � �>���r � Miscellaneous <br /> l�-µ-� / <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATLTE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixnue or appliance that meets all tlu�ee of the following requirements: <br /> 1. Does not require modification to elech�ical 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) � 1.�0 <br /> Total Pexmit F'ee S <br /> (Permit�'ees Continued On Next Page) <br /> � <br />