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� PLUMBING FIXTURES BE1NG INSTALLED <br /> FIXTURE BSMT 1 2' OTHER FIXTUR.E BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains ' <br /> Lavatory Z Sewer Ejector <br /> Bathtub � Laundry Tray <br /> Shower Washer <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 /> ❑ Yes, this section applies <br /> The replacement of a Residential fixture or appliance that meets all tlu�ee of the following requu-ements: <br /> 1. Does not require modification to electrical or gas service, y <br /> 2. Has a total cost of$�00.00 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) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />