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\ <br /> •' � <br /> ";!'�,.�3�`��°��yt;�� ,s�.µ���.����':i}"PLIJIVIB;iNGFTXTURES BEINGINSTAL'LED" '�" ��s�������, � �:h, . <br /> FIXTURE BSMT 1 2 OTHER FI�TURE 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 <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE�CALCULATION(S) I <br /> BASED OPF — 2002 STATE STATUB ' 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; 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 $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ , C' <br /> � <br /> (Permit Fees Continued On Next Page) <br /> � <br />