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� <br /> � . <br /> - PLUMBING FIXTURES BE1NG 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 J Laundry Tray <br /> / <br /> Shower / W asher <br /> ; <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ���� �� �PERMIT�FEE'CALCULATION(S)� '�� ' ' <br /> ; <br /> ` BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies � <br /> 3 <br /> The replacement of a Residential fixture or appliance that meets all tlu�ee 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 Pernut $ 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 />� � n <br /> _ � <br /> � ^; s <br /> u. � � <br /> � <br /> 2 � � ' � � <br /> G�' . � � ' � <br /> , � � � u g �,, <br /> ,i� , u; ; ;. � � ,'; � <br /> �, k � � �� <br /> i r . . ui M� � ' ".�" + .�, � � �` ��� � � � a:.. , '! � � �� :' � ��; t <br />