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rk„'= <br /> ' ,�PL�;�BI�. .... TUI.��� T�CT,��'�` ,,...;� <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1 r 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains �.,. <br /> Lavatory Sewer Ejectar <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink � Water Heater ' <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous � <br /> �— � � r°i�� Lu�L c 5 <br /> / — / G � i3,s�J <br /> j - I G E L4 YY��i f-�ry E <br /> I — l=r L� SyS-rF R•1 <br /> �-- � S���'r S S C JU�C�F-f-7 ni�S <br /> , , �. i i�� : - . . �. � .. . � f-. <br /> —_ _____ <br /> rr PERMI�I'�FEE CALCULATION(S) <br /> � � BASED OFF - 2002'�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�,SOO.QO or less;excludin�the cost of the fixture or appl�ance:and <br /> 3. Is improved,installed or replaced by the homeowner ar licensed contractor. <br /> Skip next secYion,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 /> (Permit Fees Continued On Next Page) <br /> 2 <br />