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05/18/2017 xHU 13: 41 FAx 763 473 8565 B�bre xentinq b p,ir Cond �003/407 <br /> FIXTLTRE �SMT 1' 2 0'1'li� N1X'1'URL 135M7' 1 2 OTHF.R <br /> 'I'YPL FL Fi. TVPF Ff. FT. <br /> Water Closek ` � � f�loar Drains <br /> I,avatory , � � Sewer Ejecwr F��� <br /> I3atlitub z Laundiy Truy <br /> Sktower ` Washer ' <br /> Kitchen Sink Water Heater <br /> Disposat � Warsr Softener <br /> Dishwasher l Wet Bar <br /> � Sillcocks � Misce aneous 1 <br /> [� Yos,this scx,`tion applies <br /> The renl�ce�ent of oialy one�tesidcntial fixturo or applianec that meots al[three af the following <br /> require�nents: <br /> 7. Does not require madification to el�trical or gas scrvice. <br /> 2. Yies a�of$500.00 or less;excludina the cost of the fixture or applianee: and <br /> 3, ls improved,inst�lled or feplaGecl by d�e homeowner or lice�l5ed�lumbing�ontraCtor. <br /> Skip next sectian,if this spplies; Cost of�ermit R_ . 15.44 <br /> 5tate Surcharge S 5.00 <br /> Mail-In Fee(If Applscable) $ 2.00 <br /> `I'atnl permit�'ec S <br /> (1'crmit Y'eea Continued On Next Pagc) <br /> 2 <br />