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PLLJMBiNG FIXTi.7RES BEING INSTALLED � <br /> FIXTURE BSMT 1 2 OTHER FIX'I'IJRE BSM"I' 1 2 O"I'HER <br /> TYPF. FI_ FL TYPE FL FL <br /> Water Closet � i ') Floor Drains `� <br /> ; <br /> Lavatory i ' r- Sewer Ejector <br /> Bathtub ^ Laundry Tray � <br /> Shower � W asher <br /> i /� � <br /> Kitchen Sink 4 Water I Ieater � <br /> Disposal � Water Softener ; <br /> Dishwasher I Wet Bar � i <br /> � � <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 /> I. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludina the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licenscd contractor. <br /> Skip next section,if this applies; Cost of Perrnit $ 15.00 <br /> State Surcharge $ Sp <br /> Mail-Fn Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />