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02/02/2015 MON 1Q: 55 FAx 763 a73 8565 Sabre Heating � air Cond f�006/007 <br /> FIX'I'[J�J: BSNI'I' l� 2 OT'HER FIX'ItiRL ` - - - _ _.�____ <br /> �1SMT ls�-- 2� OTI�.R <br /> TYPE FL FT. TY'1'E FL FL <br /> I Water C149at I, Ploor Drains <br /> L�vatory � Sawar Ejector <br /> Bathtub Laundry'i'ray <br /> Shower � Washer <br /> Kitchen S ink Water Heater <br /> , Diaposal Water Softaner <br /> � Aishwasher Wet�ar � <br /> � <br /> �I Silicocks Miacellaneous <br /> I�� ❑ Yes,this saction a lies <br /> PP <br /> The repiacement of only one Rersidential fi�xture ur uppliance diat meets all three of the following <br /> requirements; <br /> 1. I7ass n4t require modification to e(ectrical or gas service. <br /> 2. Has a�i�t of$SU4,00 or less; in tha coat o�'the fixture ot applianca;and <br /> 3. Ie���proved, inxtal lad or rep�aoed by the homeow�er or Gcensed plumbing contrector. <br /> Skip naxt eection,if this applies; Coet of Parmit $ 15.00 <br /> State Surcharga $ 5_00 <br /> Mail-In Fae(If Applicable) 5 2.Q0 <br /> � Total Permlt Foo $ <br /> � <br /> I <br /> �i (Pormit Fee9 Continued On Next Page) <br /> � <br /> � <br /> 2 <br /> I <br />