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Y.' <br /> PLLTMBIlVG FIXTURES BEING iNSTALLED <br /> Y ,' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT ls OTHER <br /> T�E FL FL TYPE FL L <br /> Water Closet Floor Drains <br /> I <br /> Lavatory � <br /> Sewer Ejector i <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks , Miscellaneous <br /> � <br /> PERMIT FEE CALCUI,ATiON(S) � <br /> BASED OFF -2UO2 STATE STATiIE <br /> ❑ Yes,this section applies <br /> � <br /> Ii <br /> The replacement of only one Residential fixture or aopliance that meets all three of the follow�ng <br /> requirements: , <br /> 1, Does net require modificat:an to elect;ical or gas service. I <br /> 2. Has a total cost of$500.00 or less; cxcludine the cost of the fixture or appliance: nd <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contra tor. <br /> Skip next section,if this applies; Cost of Pernut' $ 15.�0 <br /> State Surcharge g; �.- I � (j <br /> Mail-In Fee(If Applicable) $ .UO <br /> Total Permit Fee $ , �`�� <br /> !. <br /> (Permit Fees Continued On Next Page) <br /> , • .. 2 <br /> • , <br />