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, <br /> V <br /> . .�'. ... .y.. �oe �. <br /> �� ,:��,��� .�,m x�� � �,�, ... ..�; , �� '°. ' � S BE1NG INSTAL,LED �������.��� �� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1' � 2 01'HER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet 1 .� Floor Drains <br /> � <br /> Lavatory S Sewer Ejector <br /> Bathroom / Laundry Tray <br /> Shower / / Washer ( <br /> Kitchen Sink � � Water Heater � <br /> Disposal / Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � Miscellaneous <br /> ��� YERMIT 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;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 Continued On Next Page) <br /> 2 <br />