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� Nuv 0613 05:10p Stewart Plumbing Inc. 763-428-1733 p.3 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> pI�{'I"[JRE BSI�1T 1 ' 2 D OTHER FIX"CURE BSMT I T 2No pTHER <br /> TYPE FL FL TYPE FL PL <br /> Watzr Closet ( n � Floor Drains � � <br /> or <br /> Lavatory I � � Sewer Ejector <br /> Bathtub � � Laundry Tray � <br /> Showec ` � ` Washer ` q <br /> l l <br /> Kitchen Sink � Water Heater I <br /> Dispflsak t Water Sofrener <br /> I <br /> �, Dishwasher � Wet Bar } <br /> 1 <br /> Si3lcocks � Miscellaneous I <br /> i <br /> � <br /> PER�FIT FEE CALCUI,ATION{S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residentiat fixture or appliance that mcets all three ofthe following <br /> requirements: <br /> L Does not require modification to eEectrical or gas service. <br /> 2. Has a total cost of$500.00 ar less;excl_udin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ S.QO <br /> Mail-In Fee(If Appiicable) $ 2.09 <br /> Total PermiY F'ee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />