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� <br /> . � <br /> � , . nu.,. .h ,� .,, .: ''���LT�ES BEING INSTALLED ;�, �,4,��,�;'�� <br /> ' ;�� ����y�;�� ��a= <br /> ,� <br /> FIXTURE BSMT 1 2 OTHER FIXTliRE ' 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 /> � <br /> Kitchen Sinlc � Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Silicocks Miscellaneous <br /> � ,. PERMIT FEE CALCULATION(S) ;� <br /> '� BASED OFF�— 2002_STATE STATUE � � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all tluee 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; 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 Permit $ 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 />