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P U � . TNG�I�T�.tES"BEII�1.�''r��T�TALL�D ` ' <br /> FIXTURE BSMT 1 2 � OTHER FIXTLIRE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitcher.Sink �' �'��ater Heate; ' <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> : �E1tMIT�EE C.l�LCULAT ION(S) <br /> ; <br /> - . <br /> BA��D OF� .20�2 STA�E-S?`�T� , ' . <br /> Yes,this section applies <br /> The replacement of only one Residential fixture or apoliance that meets all three of the following <br /> requirements: <br /> 1. Does no[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 replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <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 />