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: —• . <br /> PLUMBTNG FIXTURES BE1NG INSTALLED <br /> � FI?LTURE BSMT 1� 2 � OTHER FIXTtiRE BSMT 1 � 2� � OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet t/ Floor Drains <br /> Lavatory , / Sewer Ej ector <br /> X <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink � Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � Miscellaneous <br /> � PERMIT FEE CALCULATION(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 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 ar licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicabie) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> � <br />