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� � �� � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains , <br /> , � <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Ttay <br /> Shower Washer <br /> Kitchen Sink Water Heater � <br /> v <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks , Miscellaneous <br /> ,��PE�tMIT,FEE;CAL�CULATION(S) � <br /> ��"5 �� �'��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 $ 15.00 <br /> " � State Surcharge $ 5.00 <br /> � Mail-[n Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ i-1-�OG <br /> � <br /> � <br /> � l <br /> � <br /> (Permit Fees Continued On Next Page� <br /> ' . , <br /> II <br /> 2 <br />