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� <br /> � <br /> ��;. ` ����� '.- `: PLUMBING FIXTURES BEING 1NSTALLED A�" ' ' <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 /> — _— —- - ------ - <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ` PERI�IIT FEE'CALCULATION(S) : �' <br /> B ASED OFF - 2002 STATE STATUE '' <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance that meets all three of the following requirements: <br /> 1. Does not require modification to elech-ical or gas service. <br /> 2. Has a total cost of$5�0.00�:;ess, excludin�the cost of ihe fixture or appliancc: 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 l�Text Page) <br /> � <br />