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PLLTMBING FIXTURES BEING INSTALLED <br /> FIXTi.JRE BSMT 1 2 OTHER FIX`CURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPF, FL FL <br /> Water Closet I � Floor Ihains � <br /> Lavatory I � Sewer Ejector <br /> Bathtub Laundry Tray , <br /> Shower Washer <br /> Kitchen Sink I Water Heater � <br /> Disposal I Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks � lviiscellarteous <br /> PERMIT FEE CALCULATION(S} <br /> BASED OFF- ?00? STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only orn Residential fixture or appliance that meets all three of the following <br /> 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 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 Pemut $ 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 />