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'Uec 11 13 03:39p Stewart Plumbing Inc. 763-428-1733 p.3 <br /> !�6 1 III I� I <br /> PLUIVIBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT I 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> R'ater Closet I � � Floor Drains � � <br /> Lavatory I � � 5ewer Ejeaor <br /> Ba[htub � Laundry Tray } <br /> } <br /> Shower ` � � Washer � <br /> t <br /> Kitchen 5ink ` ; Water Heater I <br /> i <br /> Disposal ` Water Softener <br /> I <br /> Dishwasher � ` Wet Bar 1 <br /> I , 1 <br /> Sillcocks � Nliscellaneous <br /> PERMIT FEE CALCULATIQN(S) <br /> BASED QFF -2002 STATE STAT'UE <br /> ❑ Y-es,this section applies <br /> The replacement of only one Residential fiature or ap�liance that meets al(three of the following <br /> requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.0�or less;excludina 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 of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit E'ee $ <br /> (Permit Fees Cootinued On Next Page) <br /> 2 <br /> - I-;i-l..r:T.' i x'i'.. ._ . . . _. . - <br />