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� ,� �, a� ry' ! �1���I�������', <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet l 1 Floor Drains <br /> Lavatory i 1 Sewer Ejector <br /> 1 <br /> Bathrt�et�i�:'�` Laundry Tray ` <br /> Shower 1 Washer <br /> Kitchen Sink I Water Heater <br /> Disposal Water Softener <br /> Dishwasher ; Wet Bar , <br /> Sillcocks Miscellaneous <br /> p3 ����;3,�'� Y '' ,'��� t��'' PERMIT FEE CALCULATIQN(S) � <br /> ������� '��' ` �'''�w '�� BASBD OFF - 2002�STATE STATUE� ��� � <br /> �s�d ts��i,� � i.'� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance 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 /> :i. Is improveq, instaiied or repfaced'by the homeowner or licensed contractor. <br /> Skip next section,if this app(ies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />