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I <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 /> r <br /> Lavatory � Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower � Washer <br /> Kitchen Sinh Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar � <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 20Q2 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or ap�liance that mects all three of the following requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fiature or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if this ap�lies; 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 />