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66/28/2012 02:40 7637535125 NOWTHEN PLUMBING PAGE 03/04 <br /> r . � <br /> PLUMBING F17CTURE5 BEtNG INSTA�.LED <br /> FIXTURE BSMT I• 2 " OTHER FIXTURC BSM'1� 1' : ' OrHER <br /> TYPE FL FL TYPE �L `�� <br /> Wt�ter Closet Floor Drains <br /> 1_,s►vatory Scwer E,jcctor <br /> Bathtub Laundry Tray <br /> Shower Waslter <br /> Kitchen Sink ,� W2ter Hcfl�er <br /> pisposal ,� Watcr$oftcner <br /> Dishwa5her ,� Wet 8�►r <br /> Sillcook.S Miscellancous <br /> PERMIT FEE CALCUL�TiON(S) <br /> BASCD OFF -2002 STATL• ST�TUE <br /> ❑ Yes,this section Applies <br /> Tha replacement oi�only one Residenti�l fixture o liancc that mcel:s all thrce oFth� 1'oll�wing <br /> rcquirements: <br /> J, f)oes no�.r'equire modificatiun to elcctrical or g�s servic�. <br /> Z, Has T lota.l cost of$500,00 0�less; exc din the cost oFthe fixturc or appliance: and <br /> 3. IS improved, ins[�Iled or replacad by lhe homeowneror Ilcenscd plumhing cvntrlctor. <br /> Skip nexc scctic�n, i f this applies; Cost of PeiTnit � �5•�� <br /> 5tate Surch�rge ��� <br /> Mt�il-In F�r(IFApplicable) � ?•�� <br /> Tocal Permit Fce $ <br /> (Perrnit Fces Continucd On Next P�ge} <br /> 2 <br />