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. . <br /> :�� PLUMBINGFIXTURES BEING INSTALLED . � <br /> FIXTURE BSMT 1 2' OTHER FI�TURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet i Floor Drains <br /> � <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower i Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � ��� � PERMIT FEE C�I.,CULATION(S) � <br /> ��� ��-BASED OFF�-��200��STATE STATUE ���� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tluee of the followin�requirements: <br /> 1. Does not require modification to elech�ical or gas service. <br /> 2. Has a total cost of$500.00 or less; excludin�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 Pernut $ 15.00 <br /> State Surcharge $ .�0 <br /> Ivlail-In Fee(If Applicable) $ 1.50 <br /> "d'otal Perrrii#Fee $ <br /> (Permit�'ees �ontinued On Next Page) <br /> � <br />