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� <br /> � � �. , _. <br /> . .� <br /> ; _ <br /> . � <br /> �, �: � <.� w..w.'' ,.., . �� w..w:.. � � <br /> Wx �� <br /> FIXTLJRE BSMT 1 2 OTHER FIXTURE 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 <br /> Disposal I Water Softener <br /> Dishwasher � Wet Bar <br /> Silicocks Miscellaneous <br /> � � PERMIT FEE CALCULATION(S) � , ;; <br /> } BASED OFF - 200? STATE STATUE i <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, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if this applies; Cost of Pernut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />