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Jul 21 14 01:03p Water poctors 7635351805 p.3 <br /> . . .. <br /> '' =� �?�.�J�IBI�tl3�F�T�J�t.E�'°�3�7G`�1'ST�-4L�E� - ' ` <br /> FIXTURE BS_l�iT 1� 2 07'HER FIXTURE BS1+1T 1 2' OTHER <br /> TYPE ' FL FL TYPE FL FL <br /> ti`'ater Closet Floor Drains <br /> Lavatory Sew�er�jector <br /> Bathcub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener � <br /> , <br /> Dishwasher Wet Bar <br /> Sillcocks 1�Tiscellaneous <br /> � � ' -�ER1V1[T FEE C}�.�,CCI�,ATIOrT(S) - : <br /> : B�i�.ED C7t��>:-?A02':ST.�1T�5'T1�"I"[JE <br /> ❑ Yes,this section applies <br /> The replacement of oniy one Residential fix[ure or appliance that meets all three of the followin� <br /> requirements: <br /> l. Docs not require modification to electrical or gas service. <br /> 2. Has a total cost of$�00_00 or]ess;excludine the cost of the fixture or appliance:and <br /> 3. Is irnproved,installed or ieplaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if tl�is applies; Cost of Permit $ 15_00 <br /> State Surcharge $ 5.00 <br /> Ivlail-In Fee(If Applicable) $ 2•00 <br /> 'Iotal Permit Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />