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"` �ti4.�..: . '� «<.n � ���� MBING � . � • :�LED �.o� <br /> FIXTURE BSMT 1 T 2�D OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet �- � Floor Drains �` I � <br /> Lavatory /' � � Sewer Ejector <br /> l� <br /> Bathroom /� Laundry Tray � J � <br /> 6 <br /> Shower 3 / �/ Washer I <br /> � �l <br /> Kitchen Sink > � Water Heater � <br /> l <br /> Disposal l � Water Softener l <br /> Dishwasher J Wet Bar <br /> l <br /> Sillcocks � Miscellaneous <br /> �_ . _ _ <br /> ��� <br /> � � PERMIT FEE CALCULATION(S) � � <br /> BASFD 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,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) $ 1.50 <br /> Total Permit Fee $ <br /> _.. ._---__�...__ <br /> �� <br /> (Permit Fees Continued On Next Page) �� � <br /> <:� -6- _ � <br /> �--- � <br /> 2 <br />