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. Stewart Plumbing, Inc. 7634281733 p.3 <br /> PLUMBII�iG FIXTURES BE1NG INSTALLED <br /> FtXTURE BSMT 1' 2'° OTIiER FLXTURE BSMT 1 2 OTHER <br /> '�'E FL FL TYPE FL FL <br /> Water Closet � � Floor Drains <br /> Lavatory { � Sewer Ejector <br /> � � <br /> Bathtub Laundry Tray � <br /> Shawer � y� Washer t <br /> f <br /> Kitchen Sink � Water Hcater <br /> Disposal � Water Sof�ener <br /> Dishwasher � Wet Bar <br /> Sillcock� � I�4is�ellaneous � <br /> _ � <br /> 3 <br /> PERk'b11T FE£ CAI.CULATION(S) <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only�one Residential fixture or appliance that meets all three of the foliow7ng <br /> requirements; <br /> I. Docs not require modi&cation to electrica}or gas service. <br /> 2. Has a#otal cost of$500.00 or less;excludinQ the cost of the fixture ar appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contzactor. <br /> Skip next section,if this applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) � 2.06 <br /> Total Permit Fee $ <br /> (Permit Fees Cuntinued On Next Page) <br /> 2 <br />