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PLUMBING FIXTETRES BEIt�t�I�STALLEI} <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � ,..� Floor Drains j i <br /> � <br /> Lavatory .�/ ;� Sewer Ejector <br /> /` ,.� <br /> Bathtub � � Laundry Tray <br /> Shower � i Washer I <br /> Kitchen Sink I Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar �' <br /> i =� �_.. <br /> Sillcocks "� Miscellaneous <br /> , , <br /> � PERMI`I'FEE CAL�ULATi4N(S) <br /> BASED OFF -2042 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that 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;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,ifthis applies; Cost ofPermit $ 15A0 <br /> Staie Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit F'ees Continued On Next Page) <br /> 2 <br />