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I am a registered builder OR ( ) the authorized representative - SIGNATURE OF <br />of ~, regislered builder, <br /> <br />I have r~ad and agree to the terms stated on the re~er~e side of DATE: <br /> <br />A.iMf V't'I,.t,.tE qR 973~., <br /> <br />76?-7744 <br /> <br />LOT: ! BLOCK; I SECTION: <br /> I ~ <br />WIDTH'· :DEPTH: AREA: <br /> <br />TOWNSHIP; <br /> <br />TYPE,~ PLUMBING <br />CONTRACTOR, Ill'.),, <br /> <br />PHPNE~ 769-7744 <br /> <br /> ,ITEl4 <br />N~I'E.R LINF~ ZS'f Z~e FI<ET <br />F'LUHBIN6 BAfiE FIZZ: /' <br />F'LU~?[NG SLATE '3URCHA~:~G[/ <br /> / <br /> / <br /> / <br /> / <br /> <br /> CONTRACT CITY: <br />i HAR'ION COUI' <br /> <br />SUBDIVISIO <br /> <br />VALUAT:[ON,, <br /> <br />IRANGE; <br /> <br />pEr, NIT OR APPL: MO." 53818 <br /> <br /> / <br />/ <br /> <br />94-81217 <br /> <br />TOTAE ~SSE$OED FEE'S <br />PREVIO!~S RECEIPTS <br />THiS ~ECEiPT <br /> <br />QUANTITY <br /> 1 <br /> <br />£4ALAN(,E D~JE <br /> <br /> / <br />PAYEE= -- R£C£IF'T NO: <br />tO,:.(,,E.[VLT¢ BY: !:'~ TYP,F.: CHECK :~: <br /> <br /> $ THIS IS A <br />CONSTRUCTION <br /> EQIJI~EN£NTG <br /> ALL, BECOME <br /> <br /> AMOUNT <br /> $28,,~ <br /> <br /> $20.00 <br /> $3.50 <br /> <br /> $7~,,50 <br /> <br /> $0.00 <br /> <br />0 <br /> <br /> PERMIT ~, THIS:~ERNI[ EXPIRES'iSa ~AYS FROH 2TS ISSUE OATE. ~F <br />FOR A PERIOD;OF 188 ~AYS~ OR IF CONSTRUCTION FAILS TD MEET ALL , = <br />STATE LAWS AN~ MARION COUHTY BUILDING AND ZONING OEDINANCES, THIS PERMIT <br /> AN~ VOIB. <br /> <br />/ <br /> <br />NI.../SL <br /> <br />HAR]:DIq COIINTY BUiL:OIIqG OFFI-.'I:AL,/ BY <br /> <br />~onM #t4D ~5,se REV. 4/~0 OF FICE COPY <br /> <br /> <br />