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Mar061404:53p StewartPlumbing Inc. 763-428-1733 p.3 <br /> PLUMBING FIXTURES BELNG INSTALLED <br /> F(XTIJRE BSMT I 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> �g FL PL TYPE FL FL <br /> �Vater Ctoset � � Floor Drains <br /> Lavatory 2 2 � Sewer Ejector <br /> J J <br /> Bathtub � Laundry Tra.y � <br /> Shower ` � Vl%asher � <br /> I <br /> Kitchen Sink � Wat�Heate�r � <br /> Disposal � 1Nater Softener <br /> Dishwasher � Wet Bar ' <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE ST�ITUE <br /> ❑ Yes,this section applies <br /> The replacement of only ooe Residential fixture or app{iance that meets all three ofthe following <br /> rec}u�rements: <br /> 1. Does not require modification to electrical or gas sec�ice. <br /> 2. Has a tota cost oF�500.00 or less;excludina the�ost ofthe firdure or appliance:and <br /> 3. Is improved,installed or reptaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this aQplies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Eee(If Applicable) $ Z.Q� <br /> Total Permit Fee $ <br /> (Perrnit Fees Continued On IYext Page) <br /> 2 <br />