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� <br /> � <br /> � <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTI-IER FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory r Sewer Ejector <br /> 1 <br /> Bathroom Laundry Tray � <br /> Shower ' Washer <br /> Kitchen Sink Waker I-Ieater <br /> Disposal Water Softener <br /> Dishwasher Wet Baz ` <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATIi�N(S) <br /> BASED O�'F-2(�2 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacem�t of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. s not require modification to electrical or gas service. <br /> 2. Has a to�gt 1 cost of$500.00 or less;excludina 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. <br /> State Surcharge $ .50 <br /> Mail-In Fee(If AppGcable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Nert Page) <br /> 2 <br />