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Jur�0F.�2•11:09a Robert Hoey 763-535-1805 p.2 <br /> �:. _ � - .� ._ <br /> -X � .:,�- • tC 'C � � _�i.:......y. ... _.. _ _ <br /> xj { S.,- ..^w�."..::�:�:_�v=D 5•'� <br /> - ._ ��• ,``��iF.`''�:.... <br /> FIXTURE BSMT 1 ' 2 OTHER FIXTURE BS�IT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet Floor Drains <br /> Lavatory 5ewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sinic Water Heater <br /> Disposal - _ Water Softener � - - � - <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �.:T'- aS:a..�"'�. '�i:T.rsf'-^' '^t.'z''^ ' � J "'F^ "'��x'�ty _..._ - ' <br /> �S.�'-��.��S�:i'' _ x"":' Y y___ ...'� .:.:._�_.`. _ z:v <br /> —':r,s,.�:;�1�;'�._',...�:�:i =:,�E`' ;i .x., � " ! : .'�=_�;x"�';iss ci�.:;:="� '_���;: <br /> i.T�:i r�•�._. ��e�`':c..;��:7. ..:.a:•, �x:+ �� '"��:: �r x;..�ac_.ce.�;�;:5: ;:" a�z V. <br /> ,,?��.�i a.. M � •k::�;?:i�� . _:�.:_:_.�- �.s <br /> ��^"1.�:� •..���'..,`� .'ss: ...x.? _ _ �� _ .� :e:,:��'s���v:i:Y <br /> __ i:i'..,•'.a,:�' _i�i» ..:,!2�4��,_ .�' '.�._r.�.7r=.+a.�:' .._+i . <br /> ❑ Yes,this section applies <br /> The replacement af only one Residential fixture or appliance that meets all three of ihe following <br /> requirements; <br /> 1, Does not reyuire modification to electrical or gas service. <br /> 2, Has a total cost of�500.00 or less;excludine the cost of the fixture 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 Permit S I5.00 <br /> State Surcharge $ 5.00 <br /> Vfail-In Fee(If Applicable) $ 2.00 <br /> Tot�l Permit Fee $ O�d <br /> (Permit Fees Contioued Oa re�ct Page) <br /> 2 <br />