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* <br /> � � � <br /> , <br /> PLUMBING FIXTL7RES BEING 1NSTALLED <br /> ; <br /> FI}�TURE BSMT 1 2' OTHER FIXTURE 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 W asher <br /> Kitchen Sink Water Heater <br /> Disposa] Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ��r P �, �'2 �st�/�� <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; excludino 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 $ l 5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> � <br />