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�� "� .',��.��":, �`�.w �g.'; PLUMB��NG FIXTURES BE1NG INSTAI;LED �'- � �; � <br /> FIXTURE BSMT 1'T 2 � OTHER FIhTURE 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 l <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � <br /> C]�S �;v�� �u ������� <br /> � � PERM17'FEE CALCULATION(S) � � � <br /> BASED OFF - 2002 STATE STATIJE <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) $ ].50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />