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From:7634974263 03/3l /20�4 12:02 #024 P.003/004 <br /> • l <br /> ` PLUMBING kiXT'UR�S��1NG INSTALI.ED <br /> F�XTURE 8SM'1' 1 T 2VD OTHC-.R FIXTURE BSMT 1 T 2ND OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � Floor Drains f <br /> 4 <br /> Lavatory � Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower � �Uasher <br /> }tiitctren Sink � Water Heater � � ; � <br /> �,,s�i G <br /> Disposal Water So�ftener <br /> Dishwasher Wet Bar <br /> Silicocks I Miscellaneous <br /> ��,w��� �w1 I�o��Se ►�o�l-tti �uv h� I cLy��c.-��.i r��-�u�t.,t. -{�X�„c.✓� S �cL w� <br /> ���t,,� �`��rn,M r� �� ��o a� h o�s�. �- ���,S�z�ek -�i�C`-f�w C s. Ad�_ -�oc�- ���a,i r� , <br /> 5�I(u��k�, �,�c���.. �� �a.l I o� �:�4ev H��-�e,�-�, r�e,w C.�as� �3 -�t�z, -�U� <br /> �L'v� �� E��.�' a1- 1�k.�� :��a=� �i��.c.. ��� <br /> yvt���„- -}-Z, �o�l h e�L-�e.�. <br /> � - � � PERM1'I'�'EE CALCULATION(S} � <br /> BASED OFP - 2002'STATE STATUE ' <br /> ❑ 1'zs,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to elect�•icai 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,instailed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section, if this applies; Cost of Permit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-in Fee(lf Applicable) $_..,__...2,00 '" <br /> Total Permit Fee � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />