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PLtTMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT i'" 2�" OTHER FIXTURE BSM'� 1" Z'�" ' OTHER <br /> TYPE FL �L ��'�� TYPE FL FL ,�,n l\ <br /> J�L�._1 ,�L J <br /> Water Closet � Floor Drains <br /> Lava�t�r� SewerEje�t�r ' <br /> � � <br /> � �jP.tht�ih j,�i]!?�CjI'��'(''r3� <br /> i i i i i ` i � 3 i i , i <br /> � <br /> Shower Washer <br /> 1 f <br /> Kitchen Sink � Water Heater <br /> Dispo�al � �Water Softener <br /> Dls},��'aSher � ��et iR�r� <br /> i � � � � � � � <br /> Sillcocks Miscellaneous � <br /> ' �� PERMIT FEE CALC'�ULATION(S) � � � � � �� � �� <br /> ' � ' � � � r� ncr�r� r�����: �rin�� c��,1�r�=� c-r,��rr �,� � <br /> . � l�L �/I - .s� . .(1 l.t� �J l.( i 1 VL . <br /> ❑ Yes,this section applies � <br /> The replacement of only one Residential fixture or ap,pliance that meets all tHree of the following <br /> re�uiremenYs: <br /> 1. Does not require modification to electrical or gas service. ' <br /> 2. Has a totat cost of$500.00 or Iess;exciudin�;the cost�f the fixti�re or appFiance:and <br /> �, jf:tt��PQVZ��,:'5:3:�_t"�i?1't?$?�3C?d�J�f':�1�_� J�'?1�;�111�i i;3"�:�_?�SZ��s;I,R=1�i+?j Ct?:T?":Ci�[. - - <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 /> 'Fatat Permrt Fee � $ <br /> _ . _ i <br /> (Permit Fees Continued On Next Page) � <br /> 2 <br /> i ' <br />