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� <br /> { ' <br /> P�, 'f� :i�� ��,F-�T�.J`R.�S'B°F�NG TNS�`ALLED � <br /> FIXTURE BSMT 1 2 OTII�R FIXTURE BSMT 1 2 OTI�R <br /> TYPE FL FL 5�° P TYPE FL FL ,�f€-o�Q <br /> Water Closet 1 Floor Drains <br /> Lavatory Sewer Ejector <br /> j � <br /> Bathroom , Laundry�ray � <br /> w�s� �j�K <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Baz <br /> Sillcocks Miscellaneous <br /> �.PER�ItT FEE�ALCULATION(S� � - <br /> B�1.S��3�Q�F-2f102 STATE_STATUE , <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets a11 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 Continuai On Nezt Page) <br /> 2 <br />