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� <br /> � <br /> � �'�`�,`'�;�s �� � ��..E �� �.T:�MBiNG� ' S BEING IN ��LLED �`; <br /> FIXTURE BSMT 1 21D OTHER FIXTURE BSMT 1 I 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory � Sewer Ejector <br /> Bath _ � Laundry Tray <br /> Shower � W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneo <br /> � PERMIT FEE CALCULATION(S) � <br /> BASLD OFF — 2002 STATE STATIJE <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 fi�cture 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 />