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PLUMBING FIXTURES BE1NG INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Silicocks Miscellaneous <br /> �Q,�Gll�1�I J�k,��GCQ� sf�`2 �l� (il.�'.,�"t^'����0�� ' `7� <br /> i � <br /> ,►�--�C�aC�O- <br /> PERNIIT FEE CALCULATION(S) <br /> BASED OFF-2002 SfiATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meexs 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;exciudinQ the c�st of the fixture or appliance:and <br /> 3. Is improved,installed or re�laced by the homeowner or licensed contrador. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surc6arge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continned On Nezt Page) <br /> 2 <br />