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�. + <br /> • , 1 <br /> I PLUMBING FIYTURES BElNG INSTALLED � <br /> ' FI�TURE � BSMT 1' 2' I OTHER FI�TURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains , / <br /> V <br /> Lavatory V Sewer Ejector <br /> Bathtub Laundry Tray <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 Residentia] fixture or ap lip ance 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 secrion, 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 />