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� <br /> . � <br /> � <br /> I PLUMBING FIXTURES BEING 1NSTALLED <br /> FI�TURE BSMT 1 2' OTHER F1XTliRE BSMT 1 2' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains <br /> Lavatory � � Sewer Ejector <br /> Bathtub � Laundry Tray � <br /> Shower � Washer � <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener r <br /> � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) -� <br /> BASED OFF - 2002 STATE STATUE ' <br /> ❑ Yes, this section applies <br /> The replacement of a Residential fixture or a pliance 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; 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />