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PLLJMBING FIXTCJRES BEING INSTALLED <br /> FIX'I'URE BSMT 1 2 OTHER FIXTURE FiSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 3 Floor Drains <br /> Lavatory 3 Sewer Ejector <br /> Bathtub 1 Laundry 'Tray 1 <br /> Shower 1 W asher <br /> Kitchen Sink 1 Water Heater <br /> llisposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION{S) <br /> BASED OFF- ?00? 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;excludine the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replac�;d by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Pemut $ I 5.00 <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 />