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. PLUMBING FIXTURES BEING INSTALLED ,` <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> ��4���� <br /> Water Closet � � l � Floor Drains l � <br /> Lavatory i f ,� Sewer Ejector <br /> Bathtub ` � � Laundry Tray ' <br /> Shower � W asher I <br /> Kitchen Sink �' Water Heater ' <br /> Disposal � Water Softener <br /> Dishwasher i Wet Bar ` ' <br /> � ! <br /> Sillcocks Z Miscellaneous <br /> PERMIT FEE CALCUI,ATION(S) <br /> BASED OFF - 2002 STATE STATLTE ' <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 seivice. <br /> 2. Eas a total cost of$500.00 or less; excluding the cost of the fixture or appliance: and <br /> '. 1s-i�p�t�ed;-i�t-alled-o���p�aeed-b��he-lior-�eo�er-or�ie�xsed-sont�ac�o�. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> --- I�Iail-�n-�ee-(�f-A�plisab�e-�—� 1-.-50— <br /> Total Permit Fee $ <br /> ""� l �//J//.�/^7 <br /> I/ <br /> S�/�/�r,�- <br /> (Permit Fees Continued On Next Page) <br /> � <br /> , , � <br /> � ; <br /> � , <br /> G y � � <br /> ,� � � � <br /> � F : � �: <br />