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� <br /> r � <br /> a <br /> —_ : ,.'..._�,. . ��� :' P�.,'�>��,.��c,��,µ�`".nr�`,F�IXT�URES BEING�INS TALLED�� � ' "� ', <br /> FIXT'iIRE 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 /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal VVater Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> __ __ - <br /> �' � ". PERMIT FEE CALCULATION(S) T', <br /> B�SED OFF — 2002 STATE STATUE — ' <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the foilowing requirements: <br /> 1. Does not requue modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excludin�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 Pemut $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />