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1 <br /> .� <br /> � �, ��`� , TIJRES$ETN < `�' �'� <br /> �.. v� . ,. � y, G-INSTALi,ED , , � <br /> �¢ <br /> �r„ <br /> . ,... �. <br /> �R. ...,, ... , ,��' <br /> .._ , � �,. .�:n w.._:,. <br /> FI�TURE 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 Water Softener j <br /> � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> ��L;�-� z �- / <br /> /2 0^ / <br /> ��,���: � PERMIT�FEE CALCULATION(S) � : � ��� <br /> �� �' '`" �'- �� BASED OFI' 2002 STATE STATUE ��' "` '�� � � <br /> 1 .. I <br /> ' . H � ,r.. , . .� .,... <br /> -: � .. .,-. ....:. . . ... . :. .. ' <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 requue modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excludin�the cost of the fixhue 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 Pernut $ 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 />