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� <br /> � <br /> 3� ��,.: ���,;�.:.k�� ,.�"�t � <br /> � � , , <br /> , � <br /> �, �. � ., ��... . _ � <br /> .. . . �� .�� ��. .� � <br /> FIXTURE BSMT 1 2 ° OTHER FIXTURE BSMT 1 2 ° OTT�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains ti <br /> Lavatory ` Sewer Ejector <br /> Bathroom Laundry Tray / <br /> Shower i t � Washer <br /> � <br /> Kitchen Sink � Water Heater � <br /> Disposal i Water Softener <br /> Dishwasher � Wet Bar I <br /> Sillcocks � Miscellaneous <br /> ��' � � � PERMIT FEE CALCULATION(S) � �� � � <br /> �� BASED OFF - 2002 STATF STATUE <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 /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,ifthis applies; Cost ofPermit $ 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 />