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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 1 <br /> r� <br /> Bathtub � Laundry Tray � I <br /> Shower � � Washer ;; <br /> + <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher 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 appliance 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 /> ,... . . ; _.. , _, ,_:�, . _: . , ,. . , ,a _ . ._ . . , . .,. _ � . _ a_ . .. , ._ _ . <br /> (Permit Fees Continued On Next Page) <br />� �,. � <br /> �; � <br /> � :5 � <br /> � � � <br /> . /�/ . II 3 �+: f� <br /> 1 L 1 . I�F � '' A � �I <br /> , � <br /> � � � ' �'�_ I � � �i <br /> t I'. � G �' � j� lp �+ 3 A '� �' <br /> 4; r' I� � T�. ll s. '' .", <br />.. G < :i�(�4�4 , _ " �� ��` �' � �� ��` 'ii�` �I� � e'� �� , �' �� '�' "� �'� ;I� � ��. <br />