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1 <br /> 01/1 /2013 TUE 11: 09 FAX 763 473 8565 Sabre Plumbing 6 Heating 0006/007 <br /> i it',I: 't:t Iiitr ;:� o a... c:E ��� G�1 tkAiF E <br /> FIXTURE BSMT 1ST ell' OTHER FIXTURE BSMT 1'r 2N" OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet FIoor Drains <br /> Lavatory. ( I ?) Sewer Ejector <br /> Bathtub II Laundry Tray <br /> Shower Washer <br /> Kitchen Sink 1 Water Heater <br /> Disposal Water Softener <br /> Dishw her .F_. .,c e <br /> 'WCt'�iil� <br /> Silloocks ..� Miscellaneous <br /> ❑ Yes,this section applies <br /> The replacement of only one Residential fixture or appliance that meets all three of the following <br /> requirements: <br /> 1.' Does no,t require modification to electrical or gas service. <br /> 2.1 Has a total cost of$500.00 or less;excluding 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 tins applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> - -- Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Neat Page) <br /> 2 . <br /> jk <br />