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. , J <br /> -` ° P�.�R�����;�,���>a�� ,�:PLUMBING FIXTURES�BEING�INSTALLED � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> M. <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 1 <br /> V <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> , � � r � ���PERMIT�FEE,CALCULATION(S) � � � �� W� � <br /> � �, BASED OFF =2002 STATE STATUE <br /> � <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 require 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(If Applicable) $ 1.50 <br /> Total Permit Fee $���r <br /> l � '�V <br /> (Permit Fees Continued On Next Page) <br /> � _ � ,� <br /> • � ' <br /> a <br /> 2 <br />