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. 1 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 Z' OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains � <br /> Lavatory ` t Sewer Ejector t <br /> t t <br /> Bathroom Laundiy Tray � <br /> Sho��er � Washer <br /> Kitchen Sink Water Heater <br /> Dis�osal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � 1'�v� r/� G o�}�-ar 1 i n�.5, ��,� �,�c Dov�� ���� <br /> � <br /> — �!70 �-n¢�u/� � Pti,� � rl Ij�S e vn-Pr�� <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 three of the following requirements: <br /> l. Does not require modification to electrical or gas service. I <br /> 2. Has a total cost of$500.00 or less;ezcludin�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 S <br /> (Permit Fees Continued On Next Page) <br /> � <br />