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��r 29 06 08: 05a Tim Iverson 320-274-8820 p. 3 <br /> Z � <br /> ��. PLULLNl�ING�IXTURES'BE1NG I]rI�TA:�LED �`� :::.-. , :"� . . <br /> F[XTURE BSA�1T 1 < OT(�tER FIXTURE BSMT 1 2 OTHER� <br /> TY.PE FL FL. TYAE FL FL <br /> Water Closet j .� Flour D�aii�s � <br /> l <br /> 'Lavatory i •� Sewcr•Ejcctor <br /> t <br /> '13uft�rc�c:m � �Laun�r��Trsy <br /> Sho��ver . Washer � <br /> Kit�hcri S�ink � Wator Hcater <br /> Dispossl Water Soflenor � <br /> � <br /> Dishwasher We�.Bar � <br /> S�ltcocks � I�iseelfaneous <br /> �"' `'�=�Ei�I�T FE�.CA�LCt��1T�.C�N�' :,�':�::�:`�' <br /> _ .� }:�;�:.:�;.. `;: <br /> ,-si ;�r.,;:. ,.. <br /> .'$:" ,�r;'� �y �'r'�:, <br /> .ti`. <br /> :.f�� <br /> i'� <br /> .'�7 <br /> A ��-(7F� '{�: <br /> .2 02`S�'i�'�,'E`;S7'i�TfJE`�,� <br /> ❑ Yes,this srction applies <br /> The replaeemenf ai'a Residentiai fi�rture ar.ay�liar�cc that mccts all threc of the following requiretrients: <br /> 1. �,ae�.�equire mod'rFcation ta elcctrical or gt�5 s�rvics. <br /> ?, ktas a t os of$500.00 ar less;excludinQ the cost a'f 1he fixture or appGance: and <br /> 3. ls improved, installed or rep(accd by fhe homeo�vner�r lice��s.�c)cwtitractor. <br /> Skip next seciion,if this AppFies; C.ost of Permit $ 15.00 <br /> State&urcl�arge � .SO <br /> Mail-Fn�ee(if Applicable) $ I.Sb <br /> Total P�cra�it�'ee S <br /> {Perrn•it�ecs Continued On.Nezt't�agc) <br /> ? <br />