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04/15/2014 TUE 12: 21 FAX 763 473 8565 Sabre Plumbinq & eating �003/007 <br /> � <br /> :� <br /> I'IX'T'[JFtE 13SM'I' 1' 2 OTHER FIX'I' E I3SMT 1' 2 O'T'HI�12 <br /> TYPE �'L FI_ "I'YP� FL PL <br /> Water Closet � � � Floor rains � <br /> L.avatory � � � Sewer �jector <br /> 13athtub .j Laund Tray <br /> G-� <br /> S)�ower } � Washe � <br /> l <br /> Kit�chen Sink � Water eater � <br /> bisposal I Water often�r <br /> 1 <br /> Dishwasher � Wet B r � <br /> Sillcocks � Miscel aneous <br /> I'I i <br /> � ����l,������� ` , . <br /> � � <br /> .:. �y ry 4d y1 /r G ��° f r �+ ; q 7 � �x i` Y �F <br /> `�:1u�S'�7 �,G S.7$f;Kq.'.� S. { .1 K #`?2.�,5�4 h-� <br /> � � � . ; �_ �'��� .� .��'�`�-������� ; z . . �. �,�`. ,; �,� <br /> ❑ I'es,ih�s section applies <br /> The replacement of only one Residentia!fixture or appliance at meets all three of the fol(owing <br /> requirements: <br /> 1. Does not require modification Yo electric.�I or ga service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of tl�e fixture or appliance:and <br /> 3. is improved,icislalled or replaced by the homeo er or licensed p(umbing contractor. <br /> Skip next section,if this applies; Cost of ermit $ 15.00 <br /> State Su charge $ 5.00 <br /> Mail-Tn ee(If Applicable} $ 2.00 <br /> Tots31 P rmit Fee $ <br /> (Permit T+ees Continuecf On Next Page) <br /> 2 <br />