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� ���-��� ����?`�� ,, ,;�� ��.:, _" ,�. � �3:�,�.J ��e� ��\ ��``� <br /> � <br /> . .,,.z._ ..,... .., v _ . �... ��_.. _ . . � _.� .��_,_,�•�,.. ..... . ...� ,��. ___.a . <br /> FIXTURE BSMT 1 T ZND OTNER FIXTURE BSMT 1 T ZND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � I � Floor Drains <br /> Lavatory ' � � Sewer Ejector <br /> Bathroom � Laundry Tray <br /> 'T�b� <br /> Shower � � Washer <br /> Kitchen Sink � � � Water Heater <br /> Disposal � Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � Miscellaneous <br /> � � <br /> J" *�-�2.1`�i r�c... <br /> / - Id�-.� b�;,� <br /> (- OW��..J ?Y.'i� <br /> NI?RMTT F`EE CALCUL�ITION(S) �; <br /> � BAS�D OTF - 200?��STATE STATIIE '�� � �� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixt e or a lia e that meets all three of the following requirements: <br /> 1. Does not require modification�t� lectrical or gas service. <br /> 2. Has a total cost of$500.00 or ss; cludin the cost of the fixture or appliance: and <br /> 3. [s improved, installed or r aced by the`homeowner or licensed contractor. <br /> Skip next section,if �s applies; Cost Permit $ 15.00 <br /> State Su harge $ .50 <br /> Mail-In Fe (If Applicable) $ I.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />