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� <br /> � <br /> '� `� r �. k � �r�� ,�� � ��� <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � J Floor Drains <br /> � a.fea DRaans :,. �or� <br /> Lavatory Sewer Ejector � , <br /> � � <br /> Bathroom � Laundry Tray ( <br /> Shower Washer <br /> � <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> , Dishwasher � Wet Bar � <br /> ' Sillcocks Miscellaneous <br /> i <br /> a <br /> i <br /> 1 <br /> i <br /> i <br /> PERMIT FEE CALCULATION(S) � <br /> � BASED OFF �-����2002 STATE STATUE � <br /> I <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance 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;excludine the cost of the fixture or appliance: and <br />� 3. ls 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 /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br />; <br />� (Permit Fees Continued On Next Page) <br /> 2 <br />