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`'PLUIvIBING FIXTLTRES 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 1 � Sewer Ejector <br /> Bathtub � Laundry Tray 1 <br /> Shower ' Washer I <br /> Kitchen Sink I Water Heater I <br /> Disposal Water Softener I <br /> Dishwasher I Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALGULATION(S) ' <br /> _, ,.. <br /> ,: .:. : :>, ., , <br /> .: , <br /> "� BASED OFE -2'002 STATE'STATUE ` : <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all ttu�ee of the following requu�ements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$�00.00 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 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 /> . <br /> 2 ...------ <br />