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':�'�`��"�°,;�`�'�`"�`, �,���� �x`�:: PLT:TMBING FIXTURES BEING 1NSTALI.ED <br /> 4t a �a� <br /> FIXTiJRE BSMT 1 2' OTHER PIXTURE BSMT 1' 2 OTH�R <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 I <br /> Disposal Water Softener <br /> I <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �� � � � � � � � PERMIT FE��CALCL'L,�TION(S) <br /> � BASED OPP - 2002 STATE STATLTE <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 rep'.aced by the hoiiieo�nier or iicensed 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 $ , r <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />