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� <br /> 1 <br /> _ � . <br /> ����,���. �����, �����"��. PLUMBING � � : ': S BE1NG��'I`ALLED _ , � ` <br /> FIXTURE BSMT 1'� 2�� OTHER FIXTURE BSMT 1 T 2 OTHER <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 /> I <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <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 reGuire modification to electrical or gas service. <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 Applicable) $ l.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />