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. � <br /> �,� k���..�w��. � F�L�t� ''G FIXTURES BEING INSTALLED ������� ���� � <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 01'I�R <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains i <br /> Lavatory � � Sewer Ejector <br /> Batl�ae�'I'Uf� � � Laundry Tray <br /> � <br /> Shower Washer <br /> z � � <br /> Kitchen Sink � i Water Heater <br /> l. t <br /> Disposal � � Water Softener � <br /> Dishwasher � l Wet Bar . <br /> l <br /> Sillcocks 2 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 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,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Maii-In Fee(If Applicable) $ l.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />