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PLUMBIATG FIXTURES BEIN�INSTALLED � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2N 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 /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULAT[ON(S) � <br /> BASED OFF -2002 STATE STATUE � � �� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or ap�liance 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;excluding 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 /> (.'ermit Fees Continue�l On Next Pa�e) <br /> 2 <br />