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,Jan . � � 2001 2 � 03PM NORBLOM PLUMBING No � 4055 P , 3 <br /> PLUMBTNG �'iXTCJRES SEI1vG INSTALLED <br /> F.IX'CURE BSMT I 2 OT.��R FIXTURE BSMT 1 2 OTHER <br /> TYPB FL FL TYAE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewcr Ejector <br /> Bathroom C.aundry Tray <br /> Showec Washer <br /> Kitchen Sink Water Heater / <br /> Disposal Water Softener <br /> Dishwasher �Vet 9ar <br /> Silicocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> HASED OFF - 2002 STATE STATUE <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requiroments: <br /> 1. Does not require madification to eloctrical or gas service. <br /> 2. Has a total cast of$500,OD or less;excludin2 the cost of the fixture or appliance:and <br /> 3. �s improved, installed or replaced by the homeowner or licensed conttactor. <br /> Skip next section,if this applies; Cost of Permit $ 1�.44 <br /> State Surcharga $ .50 <br /> Mail-fn Fec(If Applica6le) $ <br /> '�'otal Permit Fee $� <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />