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08/,28/?012 TU8 11: 19 FAX 763 473 8565 Sabre Plumbing 6 Heating �003/007 <br /> FIXTURE BSMT I 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL PI. <br /> Water C[oset � � Ploor Drains � <br /> Lavatory � Sewer Ejector <br /> Bathtub � Laundry Tray � <br /> Shower Wa�� <br /> < < <br /> Kitchen Sink l Water Heatcr ' <br /> Disposal WaEer Sofl:ener <br /> (. <br /> _ . Dishwasher ` Wet Bar <br /> Sillcocks � Miscellaneous <br /> ❑ Yes,this section appties <br /> The rehlttcemont af only one Resedential�xture or app(iance that meets al(three of the following <br /> roquiremen�s: <br /> l. Does noti require modi�cation to electrical or gas secviee. <br /> 2. Has a ot tal c:4�of$500.00 or less;exeluding the cost of thc frxt.uro or appliance: and <br /> 3, Is improved, installed or roplacod by tha homaovmer or licensad p[umbii�g co��lractor. <br /> Skip next section,if dus applies; Cost of Permit $ 15.00 <br /> Sinte Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2,00 <br /> Tofal Permit Fee $ <br /> (Permit Ir'ces Contiaued On Next Pagc) <br /> 2 <br />