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� <br /> � <br /> • t <br /> �, � .. . `�J�SBIl�G�FIXTURES BEING 1NSTALLED ' ; <br /> FIXTURE BSMT 1' 2 OTHER FIhTURE BSMT 1' 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �� � `'rZ <br /> �� �PERMIT�FEE CALCU:LATIQN(S)� � z <br /> __ r BASED OFF - 2002 STATE STATUE �� � <br /> � Yes,this section applies <br /> The replacement of a Residentia]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 Pemut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />