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t � 4 <br /> .E <br /> PLUMBING FIXTURES BETNG INSTALLED <br /> FIX"I'URE BSMT I�� ?�D OTHGR FIXTURG BSM"I� I�� 2��° OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ' r� `� Floor Drains � <br /> v� c �e <br /> Lavatory + � �I Sewer Ejector <br /> 1 <br /> Bathree�wksb ` Laundry Tray i <br /> I <br /> Shower 1 , � Washer � <br /> Kitchen Sink � Water Heater � <br /> Disposal i Water Softener <br /> Dishwasher , Wet Bar ' I <br /> Sillcocks � Miscellaneous <br /> 3 g��,_ <br /> ` PCRMIT FEE CALCULATION(S) <br /> BASED OF,F -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance that meets all three of the following requirements: <br /> I. 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, instalied or replaced by the homeowner or iicensed contracior. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee([f Applicable) $ 1.50 <br /> Total Permit Fee � <br /> (Permit P'ees Continued On Next Page) <br /> 2 <br />