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_ � �(� � � �� <br /> �y� �. �' ��..:,�`F �2.€��^,A. � � u .. ' _ j.j '. '' � Sg��{ � <br /> �. .._:'�_. .��.'''�,°a,, �,�2L, , ` . J��s Z <br /> • . ..,. . .....:��. 1. _«x...... - �' <br /> _ _ _ .__>�_�, , _.,:e... ._>_-"""' �-. ._.. .>a � � <br /> .-. .r-- .., ._-_ . , ... "vu,;. <br /> FIXTURE 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 ( <br /> � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �� � PERMIT FEE CALCUI�ATION(S) � <br /> � � � � BASED OFF- 2002��STAT���STATU� � <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> 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 plumbing 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 />