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PLUMBTNG�IXTURES BETNG INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink I Water Heater <br /> Disposal 1 Water Softener <br /> Dis6washer � Wet Bar <br /> Sillcocks Miscellaneous I <br /> 1-�-�x1�f <br /> �,_;�� c ����t <br /> �(`��t����,�\1i�~• <br /> _�� <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 three 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;excluding 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 />