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� <br /> � <br /> � � � � . , <br /> �. <br /> � , <br /> ... <br /> R�.� � � �� , �.�, <br /> FIXTURE BSMT 1 2 OTI-IER FIXTURE BSMT 1 2 O"I`HER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains a � <br /> Lavatory � � I Sewer Ejector <br /> �� �� Laundry Tray <br /> Shower � V Washer ' ' <br /> � <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar � <br /> Sillcocks Miscellaneous <br /> � — PERTvIIT FEE CALCULATION(S) <br /> BASFD OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appiiance 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;excludinQ the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip ne�ct section,if this applies; Cost of Permit $ 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 />