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PLUM�ING�I�TURES'BETATG INSTALLED <br /> FTXT'URE BSMT 1 2 ClTHER FTX1'lJR.E BS.MT t 2 4THER. <br /> TYPE FL PL TYPE FL FL <br /> Wacer Closet � � Pl�r Drains <br /> ___._._ _._.�....._._�..�:. ._____..------- <br /> [,a�atory } � Sewer Ejector <br /> Bathtub � � Laundry Tray <br /> Shower � Washe�' <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bt►r <br /> Silicocks Miscellaneous ----- <br /> ' �'�RMIT FEE GAI,CULATION�S} <br /> Bt�1���J t3F�-��?U2'S'�'�►'�'�STATUE <br /> ❑ Yes,this seCtion applies <br /> The re.pla�nnent of ouly orte Resid�ntiai�xture�a 1�iance tha#meets atl three of the�oltowing <br /> r�uirements: <br /> t. Dces nat x�quire m�fication ta electrical or gas serv�ce. <br /> 2. }ias a total cast of$SUQ.UO or tess;excludin�the cost oftt►e fixt�u�or a}spliance:and <br /> 3. Js improved,insta3led ar replaced by the hom�wnec or Iicensed piumbing contractor. <br /> Skip next seckion,xf this applies; Cost of Permit $ 15.00 <br /> Stsie Surchacge $ S.UO <br /> Mail-:Itt Fee(If Applicable) $ 2.00 <br /> Total Permit Fce S <br /> {Permit�ees Continued On Next Page} <br /> 2 <br />