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,,'; .�PI;UMBINC7FIXTiJRLES BEING`.TNSTALLED ; <br /> FIXTURE BSMT l s` 2"u OTHER I FIXTURE BSMT l s` 2"u OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> � <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> � <br /> Kitchen Sink I Water Heater <br /> Disposal I Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks ! Miscellaneous <br /> ' PERIVIIT,FEE:. ALCULATION(S) ` <br /> BASED OFF- 20 2 STATE,S.�ATUE. , . <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or�liance that meets all three of the following <br /> requirements: � <br /> 1. Does not require modification to electn�'cal or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by tlie 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) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />