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JAN-17-2aS4 09:21A FROM:UPS- MAGIC WATER 7634971851 T0:9522494616 P.3 <br /> � .,�,:� ` � `' �MI3ilVG�F1XTU�K'ES BETNG�INSTA�L�D � � � , ,, �: �'���� <br /> FIX1'CTRE BSMT 1 2 OTHER F1X'I'UK� BSMT l 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains <br /> Lavatory �/ Sewer Ejector <br /> Bathtub Laundry Tray ✓ <br /> Shower Washer <br /> Kitchen 5ink Water Heater <br /> Disposal Water Softener <br /> I)ishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> .�.. . „ ,�. , <br /> "' . _ �_ `�pERIv1IT FE�CAL�L)LA ION(S)���� � � <br /> . ,. �. <br /> ,. <br /> �"��� �% BASED OFF -2002 STA"T�STATUE �' <br /> ❑I Yes,this section applies <br /> The replacement of onty one Residential fixture or appliance that meets all three of the following <br /> 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 hnmeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost ofPermit $ 15.00 <br /> State Surchnrge $ 5.00 <br /> Mail-In Fee(�f Applicable) $ 2 00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />