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_ A . <br /> • <br /> PLLTMBING FIXTURES BElNG INSTALLED <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 i Laundry Tray i <br /> l <br /> Shower i Washer , <br /> Kitchen Sink l Water Heater I <br /> Disposal � Water Softener <br /> Dishwasher l Wet Bar <br /> Sillcocks � Miscellaneous <br /> � PERMIT FEE C�ALCULATION(S) ���� ��� <br /> BASED OFF - 2002 STATE STATLTE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tluee of the following requirements: <br /> 1. Does not require modificarion 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) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />