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Jun 151503:13p Legend Services Inc 763-479-6003 p.6 <br /> PLUMBING FIXTURES BEING iNSTA[,LED <br /> FIXTURE BSM'I' isr 2�fD pTHER FIXTURE E3SMT 1 2N° OTHER <br /> TYPF. FL FL TYPE k�L FL <br /> 4Vater Closet I Floor Drains <br /> 1 <br /> Lavatory r'1 Sewer Ejector 1 <br /> AC. <br /> BacE�tub Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink Water Hea;er <br /> i <br /> Disposal � WaCer Softener <br /> � Dishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,tt�is section applies <br /> The replacemeni�f only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. T�oes not require modification to electrical or gas service. <br /> 2. Nas a total co52 of$Sfl0.00 or less;excludin�the cosi of the fix[ure or appEiance:and <br /> 3. ]s improved,installed or replaced by the homeowner or lieensed p)umbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-ln Fee(LfApplicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On l�ext Page} <br /> � <br />