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, ' <br /> ,�� i � �, � „� �, ,�IXTURES BEING TN .. %�� ��.. �� �. ;, <br /> � � � . � <br /> .. <br /> ��,���,. , .,..s����� � ti. , <br /> FIXTURE BSMT 1 2 O'I73ER FIXTURE BSMT 1 2�' OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � I Floor Drains � <br /> Lavatory + Sewer Ejector <br /> F � <br /> Bathroom Laundry Tray ' <br /> Shower j � Washer � <br /> Kitchen Sink Water Heater <br /> � <br /> Disposal � Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks Z Miscellaneous <br /> ��. <br /> � PERMIT FEE CALCULATION(S) � <br /> BASED OFF — 200? STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or aPpliance that meets all t}iree of the following requirements: <br /> 1. Does not require modification to electrical ar gas service. <br /> 2. Has a total cost of$500.00 or less; excludine 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 $ .50 <br /> Mai]-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />