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_ �, <br /> a <br /> �..� <br /> ' _ �"..,. � <br /> a 3�--4�... - i. ' _ <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTFIER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains � <br /> Lavatory � Sewer Ejector <br /> BathFeerH � Laundry Tray <br /> –j�� — _ <br /> Shower / � Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal ' Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks � Miscellaneous / � <br /> � <br /> SuM�� �ic�� 1n-�.,c5+_ Id�c- �e� <br /> �`� \`"�� 1- d:so-�-v"���n-�� <br /> �'qA��� � " �-�.C.i rC.- ��� <br /> ����� <br /> : T� <br /> ` PERMIT FEE CALCULATION(S}: <br /> BASL,D U1'H'- 2002 S"CnTI� STATUE <br /> ❑ Yes,this secti applies <br /> The replacement of a Residential i re or a liance that meets all three of the following requirements: <br /> 1. Does not require modification fo�e�lectrical or gas service. <br /> 2. Has a total cost of$500.00 or less;e ludin the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> � <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcf►arPe $ .50 <br /> Mail-In Fee(I�`�plicable) $ 1.50 <br /> Total Permit Fee � $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />