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' r � <br /> _;. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains / <br /> Lavatory / Sewer Ejector <br /> Bathree�n \ i Laundry Tray � <br /> `tttib f <br /> Shower � � Washer <br /> Kitchen Sink Water Heater <br /> Disposal ( -�� I <br /> ��tT�;1,��„�. <br /> �� <br /> Dishwasher i Wet Bar <br /> Sillcocks � Miscellaneous <br /> c�o�, - � " ��P;�� _I�r._� <br /> J�'CMIc� � _ '�,,w.l�,,`�.i.�. ' <br /> ���'��I'[�RNIIT�'CE CALCULAT[4N(S) ��"��� . ��=�� � <br /> �3,�1,Sf�U 0��� - 2�02 S`i'AI'L S"I'A'I"UE'. <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;excludine 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 /> (Permit Fees Continued On Next Page) <br /> 2 <br />