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''� <br /> � <br /> � <br /> PLUMBING FIXTURES BEING 1NSTALLED. <br /> FIXTURE � BSMT ' 1 2' OTHER FIXTURE BSMT 1 2' OTHER <br /> T1'PE I FL FL TYPE FL FL <br /> Water Closet � � � Floor Drains � <br /> Lavatory � � � Sewer Ejector <br /> Bathtub � / Laundry Tray � <br /> Shower / Washer <br /> � <br /> Kitchen Sink � Water Heater / <br /> l <br /> Disposal Water Softener � <br /> Dishwasher I Wet Bar <br /> Sillcocks � Miscellaneous � <br /> � ��� 5�� � <br /> PERMIT FEE CALCULATION(S) --� <br /> BASED OFF -'2002 STATE STATUE � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or ap liance 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; excludintr 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 Surcharae $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> � <br />