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� <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 /> 1 Z <br /> Lavatory Sewer Ejector <br /> � � <br /> Bathtub Laundry Tray <br /> 1 � <br /> Shower � Washer , I <br /> Kitchen Sink ' Water Heater I <br /> Disposal Water Softener <br /> 1 <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 following requirements: <br /> 1. Does not require modification to elecn-ical or gas seivice. <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 Pernut Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />