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Jun 261510:37a Legend Services Inc 763-479-6003 p.3 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT INT 2 OTHER FIXTURE BSMT l 2 D OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory Sewer)rjectar <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink ( Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet liar <br /> Sillcoc ks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Hasa total cost of$500.00 or less;excluding 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 $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-in Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit pees Continued On Next Page) <br /> 2 <br />