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;, � <br /> +�r-+i ►'�l��Yl.t��.L�-v r��, �'1�r'��l e �,� `��� �'e `� aC 1+�e t��y S'e"{' <br /> � <br /> ' ' PLUMBING 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 Lauudry Tray <br /> x <br /> Shower W asher <br /> � <br /> Kitchen Sink Water Heater I <br /> Disposal Water Softener I ! <br /> Dishwasher Wet Bar <br /> Sillcocks Z Miscellaneous <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 tluee of the following requirements: <br /> 1. Does not require modification to electrical or gas seivice. <br /> 2. Has a total cost of$500.00 or less; excludinQ 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 />