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Y <br /> � <br /> i <br /> . ,..,�s::s,�.a, ,---, : i; . , , . . .:. , <br /> FIXTI_JRE BSMT 1 2 OTHER FIXTiJRE 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 /> 5hower � Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> I PERMIT FEE CALCULATION(S) I <br /> � BASED OFF -2002 STATE STATUE <br /> Lf 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$SOU.(�or less;excludinu the cost of the fixture or appliance:and <br /> 3. Is unproved,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 Annlicablel $ 1.50 <br /> IY�.rniu�ee�E.��c�r����ie�1 ()n i'���t Pa�;e) <br /> � <br />