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y <br /> . <br /> , <br /> ;i . . <br /> ;f <br /> :� � <br /> -� ���� �,- `��,' <br /> ,s �, , <br /> ,{ <br /> `� FIXTURE BSMT I 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> �`• TYPE FL FL TYPE FL FL <br /> � <br /> Water Closet � '� Floor Drains 3 I <br /> Lavatory � � Sewer Ejecror <br /> Bathroom � Laundry Tray <br /> � �` r`��- <br /> Shower i washer <br /> Kitchen Sink � Water Heater <br /> Disposal � Water Softener <br /> � <br /> Dishwasher Wet Bar I I <br /> Sillcocks i Miscellaneous <br /> ;j <br /> ;� <br /> :i <br /> : <br /> :� - <br /> ,� � , ,�k?I.E�.�RMZ�',F�E�CALCUI;A�"ION(S� w'> ��� , � <br /> ;; ` BASED OFF =�2002 STATE STATUE" <br /> �� <br /> `� ❑ Yes,this section applies <br />'� The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br />�� I. Does not require modification to electrical or gas service. <br />`; 2. Has a total cost of$500.00 or less;excluding 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 /> ' Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> � <br /> �� <br /> (Permit Fees Continued On Next Page) <br />,� . <br /> s <br /> i <br />; 2 <br /> F <br />