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PLiJMBING FLXTLJRES BEING INSTALLED <br /> I�IXTUI2E BSMT 1 2 OTI-IER FIXTURE BSMT 1 2 OTHI�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � *� � Floor Ihains � 2 <br /> J J <br /> Lavatory 1 � � Sewer�jector <br /> I <br /> Bathtub I � Laundry Tray � <br /> Shower S + � Washer <br /> � � <br /> Kitchen Sink � Water Heater � <br /> Disposal n Water Softener <br /> v'� <br /> Dishwasher I Wet Bar � <br /> Sillcocks llane us � <br /> � ��� <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - ?00? STATE STATUE <br /> ❑ Yes,this sec;tion applies <br /> The replacement of only one Residential f5xture or appliance that mcets all three of the following <br /> requir�,�cnents: <br /> 1. Does not require maiification to electncal 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 the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In�ee(If Applicable) $ 2.00 <br /> Totat Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />