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PLUMBING FIXTURES°BElNG INSTALLED �� <br /> FIXTURE BSMT 1 2" OTHER FIXTtiRE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ej ector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater ( <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERI�IIT FEE CALCULATION(S) : <br /> BASED OFF _200? STATE STATUE � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a plp iance that meets all three of the following requirements: <br /> 1. Does not require modification to elecri-ical or gas service. <br /> 2. Has a total cust of$50C.00 or less; excluriin�ine 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 $ 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 /> � <br />