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f7 7 <br /> � <br /> �, �.."��" P��;"," '�����`��' '. � ��`��"r S BEING INSTALLED ., '��q ,� �' , '3 � ' <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT l 2 OTHER <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 /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous � <br /> ��� �'� <br /> ��� PERMIT FEE CALCULATION(S j � �� � <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; excludin�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 $ I5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> �(�� g� <br /> 3�► <br /> (Permit Fees Continued On Next Page) <br /> ��+ � r <br /> � � <br /> 2 �-E'� <br />