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PLi�MBING FIXTURES BIING INSTALLED <br /> FIXTiJRE BSMT 1 2 OTHER FIXTURE BSMT 1 21'1D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � FSoor Diains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray � <br /> Shower ' Washer <br /> Kitchen Sink � Water Heater <br /> Disposal / Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2�2 STATE STATUE <br /> ❑ Yes,this section agplies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l. Does not requue modification to electncal or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�t the cost of the fiart�ue 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 Pemut $ 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 /> 2 <br />