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I <br /> PLUMBING FIXTURES BEING INSTALLED , <br /> FIXTURE BSMT ls' 2ND OTHER FIXTURE BSMT 16.T 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> 3 Water Closet Z Z Floor Drains <br /> Sewer Ejector <br /> Lavatory I <br /> Z Laundry Tray <br /> Bathtub ' <br /> Shower Washer <br /> Kitchen Sink Water Heater 1 <br /> Disposal t Water Softener <br /> Dishwasher Wet Bar 1 <br /> Sillcocks Miscellaneous <br /> PERMIT FEE.CALCT�LATOT(S} t <br /> -:BASET}OFF 1002 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;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> v <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />