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� <br /> � <br /> .�� �'�'�,�. �':: �z�?�,�;[MBING FIXTURES BEINGT�STAI.,I.a�,D:. � . ��;°��°-' ,. ..Y� ;. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT I 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains � <br /> Lavatory � 1 Sewer Ejector <br /> Bathroom � � Laundry Tray <br /> Shower 1 � Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar � <br /> Sillcocks 1 Miscellaneous <br /> ___._ -----. <br /> � PE;RMI I" }�CE CALCULA"l��ION(S) ��� <br /> � BA�L—:U OFF� —2002�STA'�I�;�S'I'ATiJE �� _ <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;excluding 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-[n Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />