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� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTI-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink � Water Heater <br /> L�isposz! , Wat�;S�ftene; <br /> Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> ; <br /> �� PERM[T�EE CALCULATION(S) � <br /> �� 4 r., t. ... .:�� , .. e y ��.� ,� <br /> �, `�ASED 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;excludine the cost of the fixture or appliance: and <br /> 3. Is improved, instaqed�r renlaced hy thP hornenwr.er or licer.se�c�r.trzctor. <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 />