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M - . <br /> . ` <br /> ,.a <br /> , m <br /> , ; <br /> � . , m � � � � � <br /> , <br /> � .. , ���� �.. ��,r�. .� � �� � � � � <br /> � . .. .._ vE.�,. �., � � . �. _�. �. <br /> . , � �r <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> i <br /> Lavatory r Sewer Ejector <br /> t <br /> Bathroom Laundry Tray <br /> Shower � Washer <br /> Kitchen Sink � Water Heater <br /> Disposal ` Water Softener <br /> Dishwasher Wet Bar <br /> I. <br /> Sillcocks Miscellaneous <br /> � � � PERMIT FEE CALCULATION(S) � � <br /> BASED OFF — 2002 STATE STATIJ�E <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 ne�ct section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ l.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />