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� _ -____ _ -- <br /> ° PLUMBING FIXTURES BEING INSTAI,LED � ' <br /> a„u, <br /> FIX"IURE BSMT 1's' 2��' OTH�R FIXTURE BSMT lsr 2 ° OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Draius <br /> Lavatory Sewer�jector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Wa[cr Heater <br /> Disposal Water Softener <br /> Dishwasher Wct Bar <br /> Sillcocks Miscellaneous <br /> IV�DUl.UG '���,'IiC �.lZl.(i.LH— �l�1��`C�T�C. .k:2Xr�t ��QK-� <br /> W,�'�Tl'� /��=-"��� r-� <br /> %N S 11'�z �7.�� 13,���;�c.�.�-�7 tv a��S. <br /> — - ---- <br /> � ��� ��'�fZMIT�FI-F, CALCULATION(S) �� � <br /> IN <br /> SEn OFI= ?Q02 STATE STA"I'UE��� <br /> ❑ Ycs,this section applies <br /> The replacement of only one Residential tixture or a�pliance that meets all three of the following <br /> requirements: <br /> 1. Does not reqttire modificatioi� to electrical or gas service. <br /> 2. Has a total cost of�500.00 or less;excludin�the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaccd by the homcowner or licensed plumbing cont�actor. <br /> Skip next section, if this a}�plies; Cost of Per�ni[ $ 15.00 <br /> State S�u�chargc $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Perinit Fees Continued On Nest Page) <br /> 2 <br />