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r <br /> PLUMBING FIXTURESBEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water CI oset � FI oor Drai ns <br /> Lavatory ,1 Sewer Eector <br /> d� <br /> Bathroom Laundry Tray <br /> Shower i Washer <br /> 1 <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Si I I cocks M i scd I aneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2�2 STATE STATUE <br /> ❑ Y es,thi s secti on appl i es <br /> The repl acement of a Resi denti al fi xture or a�pl i ance that meets al I three of the fol I owi ng requi rements: <br /> 1. Doesnotrequiremodificationtodectricalorg�service. <br /> 2. H as a total cost of$500.00 or I ess; exd udi nq the cost of the fi xture or appl i ance: and <br /> 3. I s i mproved, i nstal I ed or repl aced by the homeowner or I i censed contractor. <br /> Skip next section, if thisapplies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit FeesContinued On Next Page) <br /> 2 <br />