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! <br /> . � • <br /> PLUMBING FIXTURES BEING 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 /> ! <br /> Lavatory � � Sewer Ejector <br /> Bathtub � � Laundry Tray <br /> Shower I I Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous / <br /> � <br /> PERMIT FEE CALCULATION(S) <br /> � BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tlu�ee of the foilowing requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ 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 Pernut $ 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 />� <br /> .. . . �'._ �t'. <br /> l �' � <br /> . ''.. . .. . . . . .. . . : . . � L �'`. <br />. . . . .. . �. . . . . ,. . � � . � .. . <br />. . .. . . . .. .. . . . . . . . _ , t � <br /> 2 � I � � � <br /> ,. �� � � � ; � � ��. <br /> . . . . '1._ I�IIL Ik� V.� II �}� II� a' � ��y� �� <br /> k � <br /> . Y � �� '��� � � � <br /> I, �.1 IIII. . i .i . . ����jll .�; . . . �' �i � � '��' ��'�� f , �� �I �� � �� +� ��r <br />