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, Jul"19 13 01;51 p Stewart Plumbing Inc. 763-428-1733 p.3 <br /> . . � <br /> G <br /> � <br /> __ PLUMBING FIXTURES BEING 1NSTALLED <br /> �'IXTURE BSMT ls 2ND OT1iER FiXTURE BSA1T IS1' ZN OTHER <br /> TYPE FL PL TYPE EL FL <br /> V�ater Closet Floor Drains <br /> , Lavatory Se�s�er Ejector <br /> Bathtub I,aundry Tray <br /> Shower Washer <br /> kitchen Sink I Water ETeateC <br /> Disposal � R'ater Softener <br /> Dishwasher � Wet Bar <br /> I <br /> ' Sillcocks Miscellaneous � <br /> iCe. itilCt �' <br /> 1'ERMIT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE STATUE <br /> � Yes,this seetior�app(ies <br /> The re�lacement of only one Residential fixture or aP�liance that meets a!I three ofthe following <br /> requirements: <br /> ]. Does not require modificaiion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or]ess;excludin�fhe cost ofthe fixture or appliance:and <br /> 3. ts improved,installed or replaced by the homeowner or licensed p�umbing contractor. <br /> Sicip next section,if this applies; Cost of PcrmiE $ l 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicabte) $ 2.00 <br /> Total Permit Fee g <br /> (Permit Fees Contioued On IYext Page) <br /> 2 <br /> -- <br /> __r,-.:.nn� nr....�. ' _.— — <br />