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C <br /> PLIJMBINCi.FIX TIIRES;BEING;INSTALLED <br /> FIXTURE BSMT IbF 2ND OTHER FIXTURE BSMT 16T 2 ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Z j Z Floor Drains <br /> Lavatory Z y Sewer Ejector <br /> Bathreeu +u_h t Laundry Tray ' <br /> Shower I Z Washer <br /> Kitchen Sink I Water Heater j -75-6f 1L. <br /> Disposal I Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Z Miscellaneous <br /> ��TLtf2 S�niK <br /> 4 WIT.FEE CALCULATIONS} , <br /> .r SED;OFF 20U2 STATE S'I'ATUE <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 /> (Permit Fees Continued On Next Page) <br /> 2 <br />