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i � <br /> PI.UMBING FIXTURES BEING INSTALLED <br /> FIXTtJRE BSMT 1 2 OTHER FIXTIJRE BSMT 1 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 Soflener <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 require modificxtion to electrical or gas service. <br /> 2. Has a total cost of$500.�or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next secrion,if this applies; Cost of Permit $ 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 /> 2 <br />