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ti <br /> .. <br /> PLUMBING FIXTURES BElNG 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 � Washer � <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <br /> Dishwasher / Wet Bar <br /> Sillcocks •� Miscellaneous <br /> �.r, <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2002 STATE STATLTE <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; 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 Applicablej � 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />