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;�;,��.��`^�;,�;;^����;����.�;�I.' ' PLUIVIBTNG FIXTURES BETNGINSTALLED ' - <br /> FIXTiJRE BSMT 1 2 OTH�R PIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater ( <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � PERMIT FEE CALCULATION(S) � <br /> BASED OI'P - 2002 STAT� 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$SOU.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 $ .SO <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />