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, 1 <br /> � ;,�r,�:, ���`vR t�"���P � .��` �3�1G�FIXTITRES�BElNG'II�1'STAL��D�� k � ., ._��,7���': <br /> , � <br /> FIXTURE BSMT 1 2 OTHER PIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater I <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �E�IT FEr caLCLTLaT1o�v�s� <br /> � BASED OFF - 2002 STATE STA.TLT� , �m��;� <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; 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 Pernut $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $� <br /> � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />