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r <br /> PLUMBING FIXTURES 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 /> Bathtub Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener ' <br /> Dishwasher � i � <br /> ,� • / <br /> Sillcocks Miscellaneous <br /> ►�,-. � 1� I <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 /> 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 appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Y <br /> Skip next section, if this applies; Cost of Perrnit $ 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 />� <br /> � � <br /> 2 h; �' ; ; ; .� � �. z� <br /> „ , � � <br /> y, i" , � � , <br /> i � � � ,k �i { � �; <br /> , u� � ` � r� � ' t, 4 �4, ,l� � ��� <br /> ' , ' i� �i ti �,' p� � 'I( � � �r � � <br /> i . �+ ��� i ;I� '� ,�' :�' i��' 7 �' �'� � :�¢ � '�x , �' ' ��� J <br />