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! <br /> PLLTMBINGFIXTURES BEING INSTALLED <br /> , ' FIXTURE 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 /> f <br /> Bathtub Laundry Tray / <br /> Shower Washer <br /> Kitchen Sink � Water Heater <br /> Disposal % Water Softener <br /> Dishwasher / Wet Bar <br /> Sillcocks Miscellaneous / � <br /> � <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance that meets all tlu•ee 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;excludinQ 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 Pernut $ 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 />� 5 s <br /> , I � <br /> . . . .. . L �r: A` <br /> � � i <br /> � I <br /> I .�' � 4: g y � <br /> t' � . . ��4A �, � .,, �A <br /> . Xii� I� li i � <br /> 1 �t �a � � i1 �^ �' � � : � <br /> �'. � f`'�� 7 I� a� �, ., ' i� �: �. � ; �� �'` .� 'a: �.�; <br /> . . � ��� . ���� � . . �i n� . , m.� � � +�� ili� 3 � %e� F' ���� �� . ti <br />