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PLUMBING FIXTURES BEING INSTALLED <br /> � FIaTURE BSMT ' 1` 2 OTHER FIXTURE BSMT 1' ' 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains � <br /> Lavutary Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower W asher <br /> � Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � � � PERMIT FEE CALCULATION(S) � <br /> � BASED OFF- 2002 STATE STATUE ! <br /> � <br /> ❑ Yes, this section applies <br /> The replacement of a Residential fixture or appliance 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; excludine 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) $ �.—�--- <br /> Total Permit Fee $ � <br /> (���� <br /> (Permit Fees Continued On Next Page) <br /> � <br />