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�-. , w <br /> � <br /> �— PLUMBING FIXTURES BE1NG 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 r Washer I l <br /> t <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher � Wet Bar � <br /> Sillcocks � Miscellaneous � <br /> �rQ.e�.�c ��,��a"-�. . <br /> �� PERMIT FEE CALCULATION(S) � � <br /> j BASED OFF - 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 /> l. 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 /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />