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. •— - � <br /> .t , ., a ..... . <br /> »n <br /> , .-.,,, �: ��-�sP� .:_�. ,. _Ps.: r, • '',� r. �" . ... � .,� 7 �., ��yZ � -�. � <br /> FIXTURE BSMT 1 2 OTf-IER FIXTURE BSMT 1 T 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains � � <br /> Lavatory � Sewer Ejector <br /> Bathroom j Laundry Tray > <br /> � <br /> Shower ' Washer <br /> i <br /> Kitchen Sink Water Heater <br /> l <br /> Disposal � Water Softener <br /> Dishwasher ) Wet Bar ) <br /> � / <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; 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 $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />