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;,. ���,��,���� PLUMBING FIXTURES BEING INSTALLED � <br /> FIXTURE BSMT 1 T 2"' OTHER FIXTURE BSMT 1" 2' ° OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �o R u.v� wwte.v� l ��ne -�vJ- i c e u��i�e v- <br /> To Co v�v�C C,-� K�-�t(n-e,vl 5��n l� a.v�d c��S(r�c.c�c,�s(n,e cr' <br /> �o co�n�n e c� Gc.�s 5-to ve <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 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) $ l.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />