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, <br /> �''�����x���`.���`� �'�"� °���1' � �;" BING�FIXTURES BE1NG INSTALLED.7=. ' r�;� � �,��t`.� � ' - <br /> ,• f��.i1�,"���I t h�,i��lu"_.��U JaA ��i x ..a ,, -*� <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 /> PERMIT FE� CAI;CULATION(S) <br /> . BASED Ol�'F - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a� lip �ance 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�f the�ixture�r 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) $ 2.00 <br /> Total Permit Fee $ , r' <br /> r <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />