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1 <br /> ' ;��, �T; ..'� �: �TRES BElNG INSTALLED �`��"�� �' '��� � ' �`q ��: <br /> �`��' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 ZN� OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains <br /> Lavatory � � Sewer Ejector <br /> Bathroom Laundry Tray � <br /> Shower � I Washer <br /> Kitchen Sink � Water Heater � <br /> Disposal I Water Softener <br /> �'"' <br /> Dishwasher I Wet Bar 1 <br /> / <br /> Sillcocks 1 Miscellaneous <br /> � PERMIT FEE CALCULATI�N(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; 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 $ 15.0�0 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ I.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />