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, Apr29�1403:31p Huber 763-231-0295 p.7 <br /> PLUMBING FIXTliRES BEING INSTALLED E <br /> FIXTURE BSMT I'T 2`D OTtI[:R FIXTURE BSMT 1" 2N" OTHER <br /> TYP� PL FL TYPE PL F�. <br /> Water Closct 1 Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub � i I.aundry Tray <br /> Sho�ver l�t'asher <br /> Kitchen Sink �'ater Heater <br /> Disposal R'ater Sofrener <br /> Dishwasher �'et Bar i � <br /> Sillcocks 1�Ziscellaneous <br /> PERMIT FEE CALCU.LATION(S) <br /> 1 BASED OFF - 2002 STATE STATUE _ <br /> � Yes,this section applies <br /> The repIacement of only one Residential fixture or appliance that meets all three ofthe follawing <br /> requirements: <br /> I. Does not require moditication to el�ctrical or gas sen�ice. <br /> 2. Has a total cost of$500.00 or less;excludin�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, ifthis applies; Cost of Permit S i5.00 <br /> State Surcharge S >.00 <br /> Mail-]n Fee(If Applicable) � 2.00 <br /> Total Permit Fee $ 22_00 <br /> (Permit Fees Continued On�1ext Page) <br /> 2 <br />