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� � � ��� `PLUMBING FIXTURE� BEING INSTALLED� � � � <br /> FIXTUKE I3SM'I' 1'� 2"" OTHER FIXTUKE 13SMT 1'� �ND OTHER <br /> TYPE FL FL TYPE FL FI. <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <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 CALCULATIC)N(S) � <br /> B�SED OFF-2t)U2 ST�1TF �TATUE � � <br /> � Yes,lhis section applies <br /> The replacement of a Residential fixture ar a�liance that meets all lhree of lhe following requirements: <br /> 1. Does nol require modification to electrical or gas service. <br /> 2. Has a total cost ol�$500.00 or less,excludin�the cost of the fixture or appliance:and <br /> 3. is improve�, instaiied or replaccd by thc homeowner or licensed cunGacto�. <br /> Skip nexl 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 /> 2 <br />