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a <br /> _...__...__...—I <br /> ° PLUMBIN��TXTt7RES'BEING INSTALLED <br /> FIXTUKE BSMT Isr 2 OTHER FIX"1�UR1: BSM'1� I�� 2�'D O"flltiR <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink W ter Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �� PERMIT E��,E CALCULATION(S)� �� �� �� <br /> �QSED OF�' - 2002�'S'TATF: STA�I'UE <br /> ❑ Yes,this section applies � <br /> i <br /> The replacement of only one Residential fixture or appliance that meets�Ythree of the following <br /> requirements: �� <br /> 1. Does not require modification to electrical or gas sefvice. <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 replaced by the hor�eowner or licensed plumbing contractor. <br /> Skip next section, if this applies; j�Cost of Permit $ 15.00 <br /> i State Surcharge $ 5.00 <br /> i' Mail-]n Fee(lf Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Pa�e) <br /> // <br /> 2 <br />