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Ja� • 8 � 2001 2 ; 04PM NORBLOM PLUMBING No �4055 P , 6 <br /> , <br /> PLUI�lBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> � TYPE FL FL TYPE FL FL � <br /> Water Closet Floor Drains <br /> Lavatory Sewer.�jector <br /> Bathroom Laundry Tray <br /> Sbower Washer <br /> Kitchen Sink Water Heater � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> � Yes,this section applies <br /> The replacement of a Residential fi�cture er ae I�that meets al!three ofthe following requiroments: <br /> 1. Does not requir�modification to electrical or gas serviee. <br /> 2. Has a tal cost of$500.00 or less;g,xcludine the cost of the fixture or appliance:and <br /> 3. Is improved,inscalled or replaced by the homeowner or licensed conuactor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mai1-In Pee(if Applicable) $ 1.50 <br /> Total Permit Fee S �7,0� <br /> (Permit Feea Continued On Next Page) <br /> 2 <br />