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E � <br /> � <br /> � <br /> PLUM�ING FIXTURES BEING INSTALLED ' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener X <br /> / ` <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> :P�RNIIT FEE CALGULATION(S) <br /> BA SED OFF-2�2 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require mod�f;oation to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fi�cture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Pennit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 0 <br /> Total Permit Fee $�� <br /> (Permit Fees Continned On Neat Page) <br /> 2 <br />