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09/18/2013 WED 14: 29 FAX 763 473 8565 Sabre Plumbing & Heating �006/007 <br /> , � <br /> FiXTURE BSMT 1 2 OTHETt FIXTURE BSMT' 1 2 OTFiER <br /> TYPE FL FL TXPE FL FL <br /> Water Closet ' � Z F(oor Drains i <br /> Lavatory � ` � Sewer Ejector <br /> l <br /> Bathtub Z I,aundry Tray ' <br /> Shower � � Washer , <br /> Kitchen Sink � Water Heater ' <br /> Disposal ` Water Softener <br /> Dishwasher , Wet Bar � <br /> Sillcocks •-Z Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of onty one Residential fixture or aupliance that maets all three of the following <br /> requitements: <br /> 1. oes not require modification to electrical or gas service. <br /> 2. Has a t�l cost of$500.00 or Iess; xcl in the cost of the�xture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of PeRnit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable} $ 2.00 <br /> Total Permit Fec $ <br /> (Permit Fees Continae�On Neat Page) <br /> 2 <br />