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� <br /> � <br /> �, �:'����`,.����4� ':'., p�MBING F' .; .. S BE1NG INSTALLED �` ������ � �=.h,.= <br /> FIXTURE BSMT 1 2`D OTHER FIXTURE BSMT 1 2 OTf-IER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower Washer <br /> Kitchen Sink / Water Heater <br /> � <br /> Disposal � Water Softener <br /> Dishwasher % Wet Bar <br /> ( <br /> Sillcocks Miscellaneous <br /> � � PERMIT FEE CALCULATION(S) <br /> BASED 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) $ ].50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Nezt Page) <br /> 2 <br />