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� � <br /> + f. <br /> r <br /> PLLTMBING 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 i , Laundry Tray <br /> I <br /> Shower � Washer <br /> Kitchen Sink ' Water Heater <br /> � . <br /> Disposal � Water Softener i <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> PERIV�IT FEE CALCLTLATION(�) . '� <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: I <br /> 1. Does not require modification to electrical or gas seivice. <br /> 2. Has a total cost of$500.00 or less; excludine 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) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />