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, 08/Oti/2012 THU 15: 10 FAX 763 673 8565 Sabre Plumbinq & Heatinq �J004/007 <br /> � , <br /> FIXTURE BSMT I 2 OTHER PiXTURE BSMT 1 2 OT1-IER <br /> TYPC FL PL TYPG FL I=L <br /> Water Closet ' 2 I=1oor Drains ` <br /> 1 <br /> Lavatory I Sewer Ejecior <br /> Dathlub � Laundry Tray <br /> Shower ` Washer l <br /> � t <br /> Kitchen Sink Water Neater I <br /> 1 <br /> Disposnl , Water Softener <br /> _ . . . <br /> Dishwasher ' Wet B�r <br /> Sllleocks Z � Miscellaneous <br /> �., <br /> ❑ Yes,tliis section applies <br /> The replacement of only one I3esEde�a���l fixture or auy�li�nce thflt mcets all three of thc followi��g <br /> requiremenls: <br /> 1. Does not require modific�►tion to electrieAl or gas service. <br /> ?. lias a total cost of�500.00 or less;excludin�tlre cost of the frxture or appfiancc:a��d <br /> 3. Is improved,installed or replaced by!he homeowner or licensed plumbing contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surch�r�e $ 5.00 <br /> Mai!-In Fce(If'ApplicaUle) $ 2.00 <br /> 'Total Pcrmit rec $ <br /> (Permit Fees Continued On Next Pagc) <br /> 2 <br />