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Oc;16 13 09:18a Stewart Plumbing Inc. 763-428-1733 p.6 <br /> . ��� � , <br /> PLVMBING FIXTURES BEING INSTALLED <br /> F1X"I'URE BSMT 1 2ND OTHER F[XTURE BSM1 1 T 2 OTHER <br /> T�'PE F�, EL TYPE FL FL <br /> Water Closet � � Floor Drains y <br /> � <br /> Lavatory � � Sewer Ejector <br /> E3athhib i � Laundry Tray <br /> � � <br /> Shower � � 1l�rasher <br /> Kitchen Sink � r Vt'ater Heater . <br /> ; 1 <br /> Disposal � Water Sofiener <br /> Dishwasher � VY'et Bar � <br /> Sillcocks � I Miscellaneous ' <br /> PERMIT FEE CALCULATION(8) <br /> BASED OF'E' -2002 STA'TE STATUE <br /> ❑ Yes,this section applies <br /> The repEacernent of only one Residential fixture or appliance that meets a31 three of the following <br /> requirements: <br /> 1. Does noi require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excludine the cost of the fixture or app(iance: and <br /> 3. Ts improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> SkFp next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge � 5.00 <br /> Mail-1n Fee(If Applicable) $ 2.00 <br /> Total Permit Fee � <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />