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.t <br /> � <br /> ,�<, �'����i!1BIN'�.,€�i3�TI1�LE..,���'r.:, ' a ° e�� � <br /> ,� � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE 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 /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous - <br /> V�Cu�,� �r4 �r � <br /> ��� PERMIT FEE Ct�LC�UL�T10N(S) � � <br /> BASET3 OFF —2002 STATE STATUE <br /> [� Yes,this section applies <br /> /` <br /> The replacement of a Residential fixture or aonliance that meets a(1 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;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed coniractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ , v� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />