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�ct 11 06 09: 16a Tim Iverson 3z0-z74-8820 p. 5 <br /> /"k�/'� <br /> .. , <br /> :; ;. PL�IMBII�TG FIX <br /> �'t1RES B�I1��INSTALLED ��,� ,:, s .: <br /> Fr:��r� �s�r � z o��R r-i�Tur� <br /> TYPE FL FL HSMT 1 2 Q.�� <br /> 7"1'PE FL FL � <br /> V✓ater Closet <br /> Z rioor Drains � <br /> Lavatory <br /> Sewer Cjector <br /> Bathroom <br /> Laundry Tray <br /> 5ho�ver i <br /> j Wushcr <br /> Kitchen Sink <br /> ( , <br /> Water Heater <br /> Disposal � _. <br /> Water Softencr <br /> Dish�vasher <br /> � N�et�ar <br /> stttcocks l <br /> � Misccilaneous <br /> < ` �'��►+iIT REE CALCUL`ATION(S� :; . . <br /> - ''� . ;B�4,S�b:OFP _2002�STAZ�STAT�E:.? � '; <br /> ❑ Y�s,this section applies <br /> The r+eplacement af s R ' �I;'al fixture or a �" nc that meets,�I I threc of lhe foliowittg re�qujr�rttettts: <br /> '. oes require modi�Cation to eleetrical or gas S�rvjce. <br /> . Has a total cu�t af$500.00 or less;excludin�die cost of the fixiure or uppliance;and <br /> 3• Is improvnd,�nstaaled or rep�aced by the homeowner or licensed contractor, <br /> Skip�ext section,ii'tfiris appfies; Gost of Permit <br /> 5tate Surcharge �--�5'=�� <br /> Mail-In F�e{IfApplica6le} $! �`$� <br /> Tota1 Permit Fec $•—�50 <br /> (Permit Fres-Corttinued�n Next Page) <br /> � <br /> � <br />