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���` . �'�'"��'����� �'�� '.�, .. y,;�;�TXTLTRES BEING INSTALLED .': r , <br /> � ,��� ���� . <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 ' 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet I I Floor Drains /-, <br /> v <br /> Lavatory i } Sewer Ejector <br /> I <br /> Bathroom l Laundry Tray <br /> Shower , W asher <br /> ` <br /> Kitchen Sink � Water Heater � <br /> Disposal ' Water Sofrener <br /> Dishwasher i Wet Bar <br /> Sillcocks � Miscellaneous <br /> '� �J <br /> � <br /> YERNIIT FF_,E CALCULATION(S) � <br /> F3ASrD OFF - 2002 STATE STAT�UE � � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or anpliance that meets all three of the following requirements: <br /> 1. Does not reGuire 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 Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ l.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />