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, <br /> . <br /> _ ,�PIJUM$INCi FIXTIJRES.BEING IN,STALI;ED .� _ <br /> FIXT'URE 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 /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink WaterHeater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous �D <br /> '. � <� , � �ERM�T FEE CAI.C�.A,TIOi�T�S) F t.._ <br /> ��,� - � T� <br /> � °:, ,-: ._`B;;ASEA:O��.�2�002 ST�TE�STATUE � � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets al)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;excludin�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 />