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PLUMBING FTXTURES BEING INSTALLED <br /> F1XTiJI2F. BSMT 1` Z O'I'HF,R FIXTIJRE RSMT 1 2' OTHER <br /> '1'Yl'E FL FL 'rYYL 1�L 1�L <br /> Water Closet / Floor Drains <br /> Lavatory / Sewcr Ejector <br /> Bathtub Laun�'Tray <br /> Sho���er / Washer <br /> Kitchen Sink Water Ileater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Nliscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement oY a Residential fiarture or�pliance that meets all three of the follo��7ng requirements: <br /> 1. lloes 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 contractor. <br /> Skip nezt section,if this applies; Cost of Perniit $ 1�.00 <br /> State Surcharge $ .50 <br /> Mail-In Pee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />