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� 1 <br /> , � . <br /> � <br /> PLUMBING FIXTURES BEING 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 /> Bathroom � I Laundry Tray f <br /> I <br /> Shower I 1 1 Washer <br /> Kitchen Sink / � Water�-Ieater <br /> Disposal ` Water Softener <br /> ( <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 rec�uire modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; exciudin�the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeoHmer or licensed contractor. <br /> Skip ne�t 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 Neat Page) <br /> � <br />