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� <br /> ` ° ' '� n• � �F�T;�TL�RES BElNG INSTALLED <br /> �_ � :�, �, <br /> FIXTURE BSMT 1 2 OTHER FI�TURE BSMT l��� 2�'D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> 1 1 <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower W ash er <br /> 1 � <br /> Kitchen Sink Water Heater <br /> Disposal , Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 1 <br /> �� PERMIT�FEE CALCULATION(S) � <br /> BASED OF:F —2002 STATE STATUF <br /> ❑ Yes,this section applies <br /> The replacement of a Residentiai fixture or avpliance 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 $ I5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ l.50 <br /> Total Permit Fee $ <br /> . � <br /> (Permit Fees Cootinued On Next Page) <br /> 2 <br />