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Feb 13 14 03;06a RightMark Plumbing LLC 763-682-3456 p.2 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIX'['[1RE BSM"C [ 2 ° OTI-{ER FIXTURE BSMT 1 2 ° OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closei Floor Drains <br /> � <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower � Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet gar <br /> S i I Icocks Miscel laneovs <br /> PERMIT FEE CALCULATION(S} <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fi�cture or appliance that meets all three of the following <br /> requirements: <br /> 1. Dces not raquire modification to electrical or gas service. <br /> 2. Has a total cosi of�SQ0.00 or less;exeludin�the cost of the fixture or appliance:and <br /> 3. Is improved, installed or replaced by the homeowner or licensed plumbing contracior. <br /> Skip next section,ifthis applies; Cost of Permit $ i 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(IfApplicable) $ 2A0 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />