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., . <br /> e �; �� �F�. � �� �� � � <br /> �:��� :.... _..� .... ,. , , <br /> ' _ ,. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 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 /> €° -ERMIT FE� CALCUli' �}N(�} � � <br /> ����'� ��� �_,,.�SEIa OFI� -2002 STA �'ATIJ�„ <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l. 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 /> (Permit Fees Continued On Next Page) <br /> 2 <br />