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05/11/2017 THU 9: 13 FAX 763 473 8565 Sabre Heating & Air Cond 2003/007 <br /> • <br /> 1y1)C1'URE BSMT 1Yr 2"u OTHER FIXTURE BSMT 1"sT 2OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet ( 3 Floor Drains <br /> Lavatory -� t Sewer Ejector <br /> Bathtub 2 Laundry Tray <br /> Shower Washer <br /> 2. ' <br /> Kitchen Sink Water Heater <br /> Disposal 1 Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks 1 Miscellaneous <br /> If \I G;'l ri I'' } <br /> ; ; ' .t 1 '(1 , t i L', <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 /> I. Does nol require modification to electrical or gas service. <br /> 2. Has a totaLcost of 5500.00 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 this applies; Cost of Permit 5 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) <br /> Total Permit Fee S <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />