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� �� PLUMBING FIXTURES BEIN�INSTALLED <br /> FIXTURE BSMT 1" ?�" O'I�IIL:K FIXTURE BSMT 1" 2'"' O'I'HER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 2 � Floor Drains 3 <br /> Lavatory 4 � Scwcr Ejeclor <br /> 13athtub � Laundry Tray <br /> Shower � � Washcr <br /> Kitchen Sink � Water Heater � <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks 3 Miscellaneous <br /> PERMIT FEE CALCUI.ATION(S) � <br /> BASED OFF - ?O0? STATE STATUE <br /> ❑ Yes, this sec�ion applies <br /> The replacement of a Residential fixture or a�liance thal meets all three of the following requirements: <br /> 1. 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 fixlure or appliance: and <br /> 3. 1s improved,installe� o:rep:aced by the horneowner or iicensed contractor. <br /> Skip ncxl section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />