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_LUMBIN <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT FI _P�_ OTHER <br /> TYPE FL FL TYPE FL <br /> Water Closet I Floor Drains <br /> Lavatory -z Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT 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$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) $ 2.00 <br /> Total Permit Fee $ <br /> mit Fees Continued On Next Page) <br /> 2 <br />