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PLUMBING FIXT'URES BEING iNSTALLED <br /> FIXT'[JRE BSMT 1 2 OTHER FIXTtJRE F3SMT 1 2 O"I';IEI2 <br /> TYPE FL FL TYPE FL FL <br /> Water Closet , Floor Drains j <br /> I <br /> Lavatory I Sewer Ejector <br /> Bathtub I,aundry Tray <br /> Shower I Washer <br /> Kitchen Sink I Water Heater � <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks l Miscellaneous <br /> PERMIT FEE CALCULATTON(S) <br /> BASED OFF - 200? STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirernents: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exciudine 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,if this applies; Cost of Permit $ ]5_00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 <br />