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�� � <br /> ": PLUMBING FIXTURES BEING 1NSTALLED ` -� <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 /> Bathtub Laundry Tray <br /> Shower W asher ( <br /> Kitchen Sink � Water Heater <br /> Disposal Water Softener <br /> Dishwasher I 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 ap hp �ance that meets all three of the followin�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 appiiance: 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 $ .SO <br /> Maii-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />