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� ' � � � "��'` ' PLUMBING FTXTURES BEING INSTALLED <br /> a,z <br /> FIXTURE BSMT l T ���u OTHER FIXTURE BSMT 1'� 2�D 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 <br /> Dishwasher Wet Bar / <br /> l <br /> Sillcocks / Miscellaneous <br /> s <br /> � � �'ERM1T FEE CALCULA'I'�ON(S) � � <br /> BASCD OFF - 2002 STATE STATIJE <br /> ❑ 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 reGuire modification to electrical or gas service. <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 or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(lf Applicable) $ L�0 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />