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12/14/2017 THU 7: 22 FAx 763 473 8565 Sabre Heating 6 Air Cond 0003/007 <br /> t4- <br /> la,i,,.: <br /> 1 JXrORn BSM..T 1 2' OTHER PIXTURF BSMT l 2 °TITER. <br /> TYPE 1~I, FT, TYPE FL FE. <br /> Water Closet ^ I 3 Floor Drains <br /> Lavatory I f Sewer Ejector <br /> Bathtub �.. Laundry Tray <br /> Shower 1 Washer l <br /> Kitchen Sink _ Water Heater t <br /> Disposal Water Softener <br /> • Dishwasher Wet Isar 1 <br /> Sillcocks Miscellaneous <br /> lll, i`l <br /> © Yes,this section applies <br /> The replacement of only one Residential fixture of aooliance that meets all three of the following <br /> requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total gist of$500,00 or less;=Luba 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 $ i5.00 <br /> State Surcharge $ _. .. 5,00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />