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, � . <br /> .�.,,, ... � .s. <br /> rF �� �.� ° _� �` � � ', <br /> . <br /> ,, � ,, � : <br /> ��� �n� �-, rt... , .. � ....... ... �.� � ��.: <br /> �����....v m� . ,,., _ �� <br /> s _ . .__, <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2N OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathroom Laundry Tray <br /> Shower W asher <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �t S , . <br /> PF,RMIT FEE CALCULATI4N(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 /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />