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. � �I <br /> PLUMBING FIxTURES BE1NG INSTALLED �� <br /> FIXTLJRE BSMT ' 1" ' 2'-"' f�THER FIXTURE �3S1V11� I" 2'•" 01�3ER <br /> TYPE FL FL TYPE FL FL � � <br /> �('�;� .�� <br /> Water Closet � Floor Drains <br /> LF.auatory� � ,�� � SevverEjcctor <br /> i TjathjLh , i i � i T 3112!�.T'y Tr2y i i i � ('. <br /> Shower ' Washer � <br /> Kitchen Sink � Water Heater <br /> � � <br /> Disposal r �ater Saftener <br /> D1S�?W3S�:eZ i i � / i �eL�dr i � � i i <br /> { <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) '��� <br /> ri�c c rti r��r_ _ �nn� c�r n-rr- c-r n�r�T�: ' <br /> I LI:(li_r.1..a.L� L.'.1 A — u\rl��.... ..l l..i \ l L+ .�.l.i 1 4_'L� � ::I <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following I <br /> requirernents: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a toCa1 cost af$50�'.0�'ar iess;exc[udin�tfie cost of tfie fixture or appPiance:and <br /> �. TS::;[YtC�i2�,�:1�i3�:Zfs Jl;"2'}��3C��U�+r�12'1��31'?2OWi1?i 0:��CZ`:'S?t"�t t;��;:;��id1a��.,.....u.,..,,. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Totat Permit Fee S <br /> (Permit Fees Continued On Next Page) i <br /> 2 <br />